Article Abstract

Minimally invasive bronchoplastic resections

Authors: Florian Augustin, Herbert Maier, Thomas Schmid


Background: Minimally invasive lung surgery has recently proven to be superior to anterolateral thoracotomy in terms of postoperative pain and quality of life for early stage lung cancer. With these advantages, it is not surprising that surgeons all around the world try to push the limits of Video-assisted thoracoscopic surgery (VATS). Aim of this study was to explore the feasibility of a minimally invasive approach to bronchoplastic resection and to point out specific technical considerations.
Methods: Between 2009 and 2015, 15 minimally invasive bronchoplastic resections were performed using a standard 3 port VATS technique. During the same time, 463 patients underwent some form of anatomic VATS lung resection (lobectomy, segmentectomy, bilobectomy or pneumonectomy) and 21 open bronchoplastic resections using a standard posterolateral thoracotomy approach. Perioperative results of the minimally invasive group were collected in a prospectively maintained database.
Results: Median age of the patients was 57 years (17–75 years). There were 8 (53.3%) female patients. Reason for resection was primary lung cancer in all patients. Final pathology was adenocarcinoma in 4, squamous cell cancer in 5, carcinoid tumors in 4 and other types of histology in 2 patients (mucoepidermoid tumor and large cell tumor). Type of bronchoplastic procedure was simple closure of the bronchus in two patients, wedge bronchoplasty in 12 patients and circumferential sleeve in one patient. Median operative time was 217 minutes (141–390 minutes). Median chest tube duration and hospital stay was 4 days (2–50 days) and 9 days (6–63 days), respectively. Postoperative complications occurred in 2 patients (13.3%), with one atelectasis prompting bronchoscopy and one chylothorax who needed re-thoracoscopy and ligation of the cystic duct.
Conclusions: Minimally invasive bronchoplastic lung resections are feasible with a low perioperative morbidity and mortality in an experienced center. Surgeons should share their experience to clarify technical considerations like optimal sewing technique.