Video-assisted thoracoscopic surgery sleeve lobectomy with bronchoplasty: an improved operative technique.

OBJECTIVES: We summarize our experiences of video-assisted thoracoscopic surgery (VATS) sleeve lobectomy with bronchoplasty for non-small-cell lung cancer and discuss the indications and technical details of the operation.
METHODS: From September 2011 to December 2012, 15 patients underwent VATS sleeve lobectomy with bronchoplasty at our institution (right upper lobe 10, right middle and lower lobes 1, left lower lobe 2 and left upper lobe 2), with mediastinal lymphadenectomy. Three incisions were utilized. The utility incision was made at the fourth intercostal space, anterior axillary line. Simple continuous and simple interrupted suturing of the membranous and cartilaginous portions of the bronchus were performed for the anastomosis.
RESULTS: All procedures were uneventful, with a median operative time of 165 min, a median bronchial anastomosis time of 44 min and a median blood loss of 150 ml. There were no conversions to thoracotomy. There were 14 squamous carcinomas and 1 adenocarcinoma. All patients recovered well, and 1 experienced a minor complication. The median duration of chest tube drainage was 5.4 days, and the median length of hospital stay was 7 days. All patients were followed postoperatively for a range of 1-16 months without tumour recurrence.
CONCLUSIONS: VATS sleeve lobectomy with bronchoplasty is safe and effective. The utility incision placed at the fourth intercostal space, anterior axillary line, is convenient for the anastomosis, and the suturing technique is expeditious and secure. Preserving the azygos vein does not compromise exposure for the anastomosis. This technique is very suitable for centrally located lung cancers <3 cm in diameter, particularly when the cancers are located within the brachial lumen.