Cardiothoracic Surgery |

Robotic-Assisted Video-Thoracoscopic Completion Right Pneumonectomy for Recurrent Non-small Cell Lung Cancer After Prior Right Lower Lobectomy: A Case Report FREE TO VIEW

Eric Toloza, MD; Anna Cheng; Carla Moodie, PA-C; Vanessa Prowler, MD; Joseph Garrett, ARNP-C
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Moffitt Cancer Center, Tampa, FL

Chest. 2014;145(3_MeetingAbstracts):37A. doi:10.1378/chest.1836721
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SESSION TITLE: Surgery Case Report Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Completion pneumonectomy after prior ipsilateral lung resection is associated with higher morbidity and mortality compared to primary pneumonectomy. Robotic-assisted video-thoracoscopic surgery is being used more commonly for pulmonary lobectomy but has rarely been used for pneumonectomy and has not been reported for completion pneumonectomy.

CASE PRESENTATION: A 57-year-old man, who is 6 years status post right lower lobectomy for pT1N0M0 adenocarcinoma with adjuvant chemotherapy, is diagnosed with right upper lobe recurrent non-small cell lung cancer and right hilar lymphadenopathy. Preoperative staging studies revealed no distant metastasis, and the patient consented to robotic-assisted video-thoracoscopic completion pneumonectomy and mediastinal lymph node dissection. With the patient in lateral decubitus, three thoracoscopy ports were utilized, including a 4-cm camera port incision, which doubled as the assistant’s access port, along the 6th intercostal space at the anterior axillary line and 1-cm instrument ports along the 3rd intercostal space at the anterior axillary line and along the 9th intercostal space at the posterior axillary line. After pleurolysis, the remaining right lung was resected in 3 intraoperative stages, first right middle lobectomy, then right upper lobectomy, and then resection of the remaining right hilar bronchial and pulmonary arterial sleeves at the right mainstem bronchus and right main pulmonary artery, respectively, with the 3 components individually removed in an endopouch through the 6th intercostal port incision. Frozen section confirmed negative final resection margins. Operative (skin-to-skin) time was 457 min; intraoperative estimated blood loss was 600 mL. Hospital course was complicated by sinus tachycardia requiring beta-blockade and urinary tract infection requiring antibiotics, The patient was discharged home on postoperative day#8. Pathology revealed 2.5-cm right upper adenocarcinoma, with right middle lobe and level 11 lymph node metastases (pT4N1M0).

DISCUSSION: Minimally-invasive video-assisted thoracoscopic (VATS) surgery has significant advantages for patients, but is more challenging to surgeons, compared to open thoracic surgery via thoracotomy. Robotic-assisted video-thoracoscopy provides ergonomic, visual, and technical advantages for the surgeon compared to VATS surgery.

CONCLUSIONS: We have successfully performed the first reported robotic-assisted video-thoracoscopic completion pneumonectomy.

Reference #1: None.

DISCLOSURE: The following authors have nothing to disclose: Eric Toloza, Anna Cheng, Carla Moodie, Vanessa Prowler, Joseph Garrett

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