![]() Alternatively, a positron emission tomography (PET)-CT was performed. When lung cancer of a radiologically solid type was strongly suspected, remote metastasis was excluded by the results of a whole-body bone scan, abdominal ultrasound examination, brain MRI, and enhanced chest computed tomography (CT) scan. The 12 patients in this study underwent an initial case evaluation for the appropriateness of conducting the VATS operation. The Shanghai Pulmonary Hospital institutional ethics committee approved this retrospective study (IRB No. Below, we describe the method in detail, as well as the results of its clinical application to a consecutive case series. In this paper, we introduce a novel surgical technique for the safe management of calcified hilar lymph nodes. In a case series of 232 VATS lobectomies, 40% (6/15) of the conversions occurred after impairment of the pulmonary artery and difficult lymph node management ( 15). Mal-manipulation of the hilar lymph nodes frequently leads to arterial injury and massive bleeding, which in most circumstances requires open thoracotomy for bleeding control. The most common reasons for this include unexpected vessel injuries and uncontrollable bleeding, intense hilar adhesions, and extensive disease progression to the hilum ( 14). The utilization of VATS has also increased due to its attractiveness as a minimally invasive modality with significantly reduced postoperative complications and length of hospital stay ( 9- 12).ĭespite these improvements, however, conversions to open thoracotomies occasionally occur, with an incidence rate ranging from 2% to 20% ( 13). As the technology has continued to improve, it is now applied in more surgical fields, such as lobar sleeve resection, pulmonary artery repair, and even tracheal and carinal reconstruction ( 6- 8). In 1992, the first VATS lobectomy incorporating anatomic hilar dissection was performed. ![]() Within the last three decades, the use of video-assisted thoracoscopic surgery (VATS) has evolved from initial observation and biopsy to surgical resection and reconstruction ( 1- 5). Keywords: Thoracoscopy nail lymph nodes conversion surgery Two patients experienced minor complications, one pulmonary infection and another postoperative subcutaneous emphysema.Ĭonclusions: The proposed “scissor first” technique provides an effective solution for the thoracoscopic management of calcified hilar lymph nodes, and is a safe and effective method for avoiding arterial injury and conversion. The average operation time was 125 minutes, the mean blood loss was 275 mL, and no intra-operative massive bleeding occurred. Using this new technique, no conversions to thoracotomy occurred. We performed five right-upper lobectomies, three right-middle lobectomies, three right-lower lobectomies, and a left-lower lobectomy. Results: Seven male and five female patients participated in this study, with an average age of 72.5 years. These techniques are illustrated in detail. The space between the bronchus and lymph nodes is exposed by sharp dissection (“scissor first”) either before or after suturing the artery. To avoid vessel injuries and subsequent massive bleeding, we developed two techniques specific to the position and exposure of the target vessels and nodes. However, calcification of the hilar lymph nodes was discovered during the operations, and its presence hampered the conventional process of pulmonary artery dissection. Methods: The 12 cases in this study were initially evaluated as eligible and were subsequently scheduled for thoracoscopic lobectomies. ![]() Interviews with Outstanding Guest Editorsīackground: Our objective in this paper is to introduce a new method for handling calcified hilar lymph nodes during lobectomies by video-assisted thoracoscopy that effectively avoids arterial injury and possible conversions. ![]()
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