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Communications to the Editor |

Minimally Invasive Technique for Bronchoplastic Procedure FREE TO VIEW

Domenico Galetta, MD; Maria Grazia Serra, MD
Author and Funding Information

Affiliations: Institut Mutualiste Montsouris Paris, France,  Ospedale Maggiore di Milano Milan, Italy

Correspondence to: Domenico Galetta, MD, Thoracic Department, Institut Mutualiste Montsouris, 42, Blvd Jourdan, 75014 Paris, France; e-mail: mimgaletta@yahoo.com



Chest. 2002;122(4):1495. doi:10.1378/chest.122.4.1495
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To the Editor:

We read with great interest the recent article on minimally invasive techniques by Santambrogio and colleagues (February 2002).1 They reported the case of a young female patient with a bronchial mucoepidermoid carcinoma who was successfully treated by a video-assisted sleeve lobectomy.

Video-assisted thoracoscopy (VAT) has increased interest in using this minimally invasive approach for many thoracic surgical procedures. In fact, it is commonly considered to be an effective and less invasive modality for the management of benign and malignant pulmonary and pleural diseases2and for the repair of bronchial defects in some cases,34 allowing shorter convalescence and hospitalization, lower morbidity and mortality, and lower overall cost.5

The originality of the technique of Santambrogio et al is the accomplishment of a sleeve lobectomy through a very small “utility thoracotomy” using thoracoscopic guidance.

For an accurate interpretation of their technique and results, it would be important to know the intervention time, whether the procedure was completed using conventional or thoracoscopic surgical instruments, whether an extended lymphadenectomy was carried out, and, finally, whether there were perioperative complications.

In our opinion, in properly selected patients and for surgeons with VAT skills, this operative procedure could become a valid therapeutic option for the treatment of patients with benign and early malignant (stage I) bronchial neoplasms arising from the major bronchi. Radical surgical procedures are recommended for patients with most advanced malignant bronchial diseases.

Santambrogio, L, Cioffi, U, De Simone, M, et al (2002) Video-assisted sleeve lobectomy for mucoepirmoid carcinoma of the left lower lobar bronchus: a case report.Chest121,635-636. [PubMed] [CrossRef]
 
Walker, WS, Craig, SR Video-assisted thoracoscopic pulmonary surgery: current status and potential evolution.Eur J Cardiothorac Surg1996;10,161-167. [PubMed]
 
Saw, E, Ramachandra, S, Franco, M, et al Video-assisted thoracoscopic closure of postpneumonectomy bronchopleural fistulas.Surg Laparosc Endosc1997;7,73-76. [PubMed]
 
Spaggiari, L Video-assisted Abruzzini technique for bronchopleural fistula repair: a pathology study.J Cardiovasc Surg2000;41,957-959
 
McKenna, RJ, Jr Thoracoscopic evaluation and treatment of pulmonary disease.Surg Clin North Am2000;80,1543-1553. [PubMed]
 
To The Editor:

We are grateful for the opportunity to reply to the interesting comments made by Drs. Galetta and Grazia Serra on our article that was published in CHEST (February 2002).1

Video-assisted thoracic surgery (VATS) is now widely accepted for the treatment of many intrathoracic diseases.2 Indications for VATS are advancing to more complex procedures, such as anatomic pulmonary lobectomy, mediastinal lymph node sampling for lung cancer, lung cancer resectability, and pulmonary exeresis with radical lymphadenectomy for the treatment of patients with primary lung cancer.24 The advantages of VATS include minimized pain, better cosmetic results, a shorter hospital stay, and fewer complications.4

In our case, the surgical time was 5 h. The procedure was performed using both standard thoracoscopic and conventional surgical instruments. Through the utility thoracotomy, we used an anatomic forceps for the exact holding of the bronchial and hilar structures, and Duval forceps to distend the lung parenchyma and to facilitate the surgical knots.

An accurate and extended lymphadenectomy of all mediastinal, hilar, interlobar, and paraesophageal nodes was carried out. We reported neither perioperative nor postoperative complications.

We believe that the indications for VATS in the hands of experienced surgeons may be more widespread than previously anticipated.

References
Santambrogio, L, Cioffi, U, De Simone, M, et al Video-assisted sleeve lobectomy for mucoepidermoid carcinoma of the left lower lobar bronchus: a case report.Chest2002;121,635-636. [PubMed] [CrossRef]
 
Morikawa, T, Katoh, H, Takeuchi, E, et al Technical feasibility of video-assisted lobectomy with radical lymphadenectomy for primary lung cancer.Surg Laparosc Endosc1998;8,466-473. [PubMed]
 
McKenna, RJ, Jr Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer.Thorac Cardiovasc Surg1994;107,879-881
 
Loscertales, J, Jimenez-Merchan, R, Arenas-Linares, C, et al The use of videoassisted thoracic surgery in lung cancer: evaluation of resectability in 296 patients and 71 pulmonary exereses with radical lymphadenectomy.Eur J Cardiothorac Surg1997;12,892-897. [PubMed]
 

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References

Santambrogio, L, Cioffi, U, De Simone, M, et al (2002) Video-assisted sleeve lobectomy for mucoepirmoid carcinoma of the left lower lobar bronchus: a case report.Chest121,635-636. [PubMed] [CrossRef]
 
Walker, WS, Craig, SR Video-assisted thoracoscopic pulmonary surgery: current status and potential evolution.Eur J Cardiothorac Surg1996;10,161-167. [PubMed]
 
Saw, E, Ramachandra, S, Franco, M, et al Video-assisted thoracoscopic closure of postpneumonectomy bronchopleural fistulas.Surg Laparosc Endosc1997;7,73-76. [PubMed]
 
Spaggiari, L Video-assisted Abruzzini technique for bronchopleural fistula repair: a pathology study.J Cardiovasc Surg2000;41,957-959
 
McKenna, RJ, Jr Thoracoscopic evaluation and treatment of pulmonary disease.Surg Clin North Am2000;80,1543-1553. [PubMed]
 
Santambrogio, L, Cioffi, U, De Simone, M, et al Video-assisted sleeve lobectomy for mucoepidermoid carcinoma of the left lower lobar bronchus: a case report.Chest2002;121,635-636. [PubMed] [CrossRef]
 
Morikawa, T, Katoh, H, Takeuchi, E, et al Technical feasibility of video-assisted lobectomy with radical lymphadenectomy for primary lung cancer.Surg Laparosc Endosc1998;8,466-473. [PubMed]
 
McKenna, RJ, Jr Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer.Thorac Cardiovasc Surg1994;107,879-881
 
Loscertales, J, Jimenez-Merchan, R, Arenas-Linares, C, et al The use of videoassisted thoracic surgery in lung cancer: evaluation of resectability in 296 patients and 71 pulmonary exereses with radical lymphadenectomy.Eur J Cardiothorac Surg1997;12,892-897. [PubMed]
 
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