73 - Videositzung
16. Mai 2019, 17:30 - 19:00, Bellavista 2, 6. OG
3D video-assisted uniportal anatomical en bloc resection of lung segments 6 and 10 on the left
G. J. Kocher, P. Dorn, R. A. Schmid, Presenter: G. J. Kocher (Bern)
The uniportal video-assisted approach is increasingly used for anatomic lung resections all over the world. While in many centers this approach has become a standard for VATS lobectomy for early stage NSCLC, segmentectomies are still not routinely perfomed by many centers. Although segementectomies are often more challenging, there are technical advancements such as high resolution (HD) videoscopes as well as near-infrared fluorescence imaging systems that have somewhat faciliated these procedures. In this video we demonstrate the advantages of a 3D videoscope, which is especially useful for uniportal surgery, during a uniportal segmentectomy.
A 58-year old male patient presented with a spiculated lesion measuring 17x18mm in his left lower lobe. CT-guided biopsy confirmed the diagnosis of squamous cell carcinoma and PET-CT did neither show signs of locoregional or mediastinal lymph node involvement, nor distant metastasis. Since the tumor was located exactly in between segments 6 and 10, the decision for a uniportal VATS combined anatomical segmentectomy of the aforementioned segments was made. For better visualisation we chose to use a 3D, 30° videoscope which allows for 3D-image rotation without loss of horizon (Endoeye 3D, 10mm, 30°; Olympus).
Through a 3cm incision in the midaxillary line the fifth intercostal space was entered and a combined en bloc uniportal VATS anatomical segmentectomy of segments 6 and 10 with radical mediastinal lymphadenectomy was performed. Operating time was 180 minutes with a total blood loss of 150ml. The postoperative course was uneventful with chest tube removal on POD 1 and patient discharge on POD 3. Postoperative histopathologic stage was pT1c, pN0, cM0.
3D visualization with the possibility for 3D image rotation without loss of horizon is a useful tool for endoscopic surgery. Especially when choosing a uniportal access where the camera enters the same incision as all the other instruments, 3D imaging may improve orientation and with that the safety and the precision of the surgical procedure. The video illustrates these advantages on the example of a combined S6/S10 resection with a fissure-based approach for S6 and a ligamentum based approach for S10.