Techniques in Minimally Invasive Thoracic Surgery

Preface
Contents
Part I: Lung
1: Establishment of a Minimally Invasive Thoracic Surgery Program
1.1 Introduction
1.2 How to Set Up an Excellent Surgical Team for Minimally Invasive Surgery
Team Approach
Creating a Learning Team
Framing the Challenge
Creating an Environment of Psychological Safety That Fosters Communication and Innovation
Preparation
Prepare for the Worst, Hope for the Best
Conversion to Thoracotomy or Sternotomy
Management of Intraoperative Bleeding
Check Possible Clues to Prevent Reoperation Before Leaving the Operating Room After Surgery
Record the Quality Notes and Feedback
1.3 Conclusion
References
2: Video-Assisted Thoracic Surgery Wedge Resection for Primary Spontaneous Pneumothorax
2.1 Introduction
2.2 PSP Surgical Indication
2.3 PSP Surgery Using VATS
2.4 PSP Recurrence After VATS
2.5 Conclusions
References
3: Surgical Planning and the Division of the Intersegmental Plane During Thoracoscopic Segmentectomy
3.1 Introduction
3.2 Preoperative Planning and Simulation
3.3 General Surgical Technique
Exposure of the Hilar Structures
Lifting the Distal Stump of the Vessels or Bronchus
3.4 Identification of the Intersegmental Plane
Inflation–Deflation Method
Perfusion Method
Virtual-Assisted Pulmonary Mapping
Division of the Intersegmental Plane
3.5 Conclusion
References
4: Video-Assisted Thoracic Surgery Lobectomy
4.1 Introduction
4.2 Definition and Indications
4.3 Patient Assessment and Preparation
4.4 General Anesthesia and Positioning
4.5 Port Placement
4.6 Main Procedure
4.7 Conclusion
References
5: Video-Assisted Thoracic Surgery Bronchial Sleeve Lobectomy
5.1 Introduction
5.2 Methods
Anesthesia
Patient Position and Port Placement
Surgical Procedures
5.3 Video Clips
Right Middle Lobe Sleeve Lobectomy
Left Lower Lobe Sleeve Lobectomy
5.4 Conclusion
References
6: Video-Assisted Thoracic Surgery for Pneumonectomy
6.1 Introduction
6.2 Indications for VATS Pneumonectomy
6.3 Preoperative Evaluation
6.4 Anesthesia
6.5 Surgical Technique
General Concept
Patient Positioning
Incision
Division of Pulmonary Veins
Division of Pulmonary Artery
Division of Bronchus
Coverage of Drainage after Bronchus Stump
Drainage After VATS Pneumonectomy
6.6 Postoperative Management
Pleural Space After Pneumonectomy
Fluid Management
6.7 Conclusion
References
7: Video-Assisted Thoracic Surgery Mediastinal Lymph Node Dissection in Lung Cancer Surgery
7.1 Introduction
7.2 Port Placement
7.3 Techniques of VATS Mediastinal Lymph Node Dissection
Right Side
Stations 2R, 3, and 4R
Station 7 (Right Side)
Left Side
Stations 5 and 6
Station 4L
Station 7 (Left Side)
References
8: Prevention and Management of Complications During Video-Assisted Thoracic Surgery Lung Resection and Lymph Node Dissection
8.1 Introduction
8.2 Bleeding
8.3 Bronchus Injury, Fused Interlobar Fissure, and Air Leak
8.4 Miscellaneous Tips to Manage and Prevent Intraoperative Events
References
9: Robot-Assisted Thoracic Surgery in Non-Small Cell Lung Cancer
9.1 Introduction
9.2 Indications and Contraindications of Robotic Surgery
9.3 Learning Curve of Robotic Surgery
9.4 Operative Technique
General Considerations
Port Mapping
The 4-Port Approach
The 3-Port Approach
The 2-Port Approach
The Five Types of Lobectomy
Right Upper Lobectomy
Step 1: Isolation and Division of the RUL Vein
Step 2: Isolation and Division of the Anterior Trunk of the Pulmonary Artery
Step 3: Isolation and Division of the Posterior Ascending Artery
Step 4: Isolation and Division of the RUL Bronchus
Step 5: Completion of the Fissure
Step 1: Isolation and Division of the Posterior Ascending Artery
Step 2: Dissection of the Pleura at the RUL Bronchus and Bronchus Intermedius Bifurcation
Step 3: Isolation and Division of the Anterior Trunk of the Pulmonary Artery
Step 4: Isolation and Division of the RUL Bronchus
Step 5: Isolation and Division of the RUL Vein
Right Middle Lobectomy
Step 1: Dissection and Division of the Major Fissure
Step 2: Isolation and Division of the RML Vein
Step 3: Isolation and Division of the Middle Lobar Bronchus
Step 4: Isolation and Division of the Middle Lobe Artery
Right Lower Lobectomy
Step 1: Division of the Inferior Pulmonary Ligament
Step 2: Isolation and Division of the Inferior Pulmonary Vein
Step 3: Isolation and Division of the Lower Lobe Artery
Step 4: Isolation and Division of the Lower Lobe Bronchus
Left Upper Lobectomy
Step 1: Isolation and Division of the Superior Pulmonary Vein
Step 2: Division of the Lingular Segmental Arteries and Posterior Pulmonary Artery Branches
Step 3: Isolation and Division of the LUL Bronchus
Step 4: Isolation and Division of the Apicoposterior Segmental Artery
Left Lower Lobectomy
Step 1: Division of the Inferior Pulmonary Ligament
Step 2: Isolation and Division of the Inferior Pulmonary Vein
Step 3: Isolation and Division of the Lower Lobe Bronchus
Step 4: Isolation and Division of the Lower Lobe Pulmonary Artery
9.5 Conclusion
References
Part II: Esophagus
10: Thoracoscopic Esophagectomy for Esophageal Cancer: Detailed Procedures and Review
10.1 Introduction
10.2 Various Approaches of Thoracoscopic Esophagectomy
10.3 Personal Procedures Performed by the Author
10.4 Surgical Pitfalls
10.5 Literature Review
10.6 Conclusion
References
11: Video-Assisted Thoracoscopic Surgery Intrathoracic Anastomosis Technique ─ The Extracorporeal Anastomosis Technique
11.1 Introduction
11.2 Preoperative Workup and Planning
11.3 Operative Techniques
Anesthesia
Abdominal Phase: Gastric Mobilization
Abdominal Phase: Gastric Tube Formation
Abdominal Phase: Pyloric Drainage Procedures and Feeding Jejunostomy
Thoracoscopic Phase (VATS Phase): Positioning and Port Placement
Thoracoscopic Phase (VATS Phase): Esophagectomy and LN Dissection
Thoracoscopic Phase (VATS Phase): Extracorporeal Introduction of the Circular Stapler
Thoracoscopic Phase (VATS Phase): Intrathoracic Anastomosis
11.4 Discussion
Lateral Decubitus Versus Prone Position
Hand-Sewn Versus Side-to-Side Linear Stapling Versus End-to-End Circular Stapling
Extracorporeal Anastomosis Versus Intracorporeal Anastomosis
11.5 Conclusion
References
12: Robot-Assisted Thoracoscopic Esophagectomy with Total Mediastinal Lymphadenectomy: A Guide to a Systematic Approach Using the Concept of Fascial Plane Dissection
12.1 Introduction
12.2 Port Placement and Patient Position
12.3 Dissection of the Upper Mediastinum
Practical Anatomy of the Upper Mediastinum
Dorsal Part Dissection
Ventral Part Dissection
Dissection Along the Left Recurrent Laryngeal Nerve
12.4 Middle to Lower Mediastinum Dissection
12.5 Bilateral Selective Neck Dissection
12.6 Gastric Mobilization and Anastomosis
12.7 Discussion
References
13: Totally Robotic Esophagectomy
13.1 Introduction
13.2 Abdominal Phase
Ports and Arms
Liver Retraction
Abdominal Lymph Node Dissection
Greater Omentum Division
Pyloromyotomy
Graft Formation
13.3 Thoracic Phase
Ports and Arms
Upper Mediastinum and Dissection of Lymph Nodes Along the Right Recurrent Laryngeal Nerve
Dissection of Lymph Nodes Along the Left Recurrent Laryngeal Nerve
Lower Mediastinum and Thoracic Duct Control
Gastric Pull-Up and Anastomosis
13.4 Outcomes
13.5 Discussion
13.6 Conclusion
References
14: Management of Anastomotic Leakage
14.1 Introduction
14.2 Conservative Management
14.3 Endoscopic Stent
14.4 Endoscopic Vacuum Therapy
14.5 Surgical Treatment
14.6 Conclusion
References
Part III: Others
15: Video-Assisted Thoracoscopic Surgery Thymectomy: Transpleural Approach
15.1 Introduction
15.2 Procedures and Techniques
Anesthesia
Position of the Patient and Surgery Team
Instruments
Ports Placement
Thymectomy
Handling of Specimens
15.3 Conclusion
References
16: Video-Assisted Thoracic Surgery Thymectomy: Subxiphoid Approach
16.1 Introduction
16.2 Indications
16.3 Anatomy of the Subxiphoid Area
16.4 Procedure
Anesthesia
Position
Surgical Instruments
Incision and Port Placement
Incision (Fig. 16.3)
Port Placement
Thymectomy
Postoperative Management
16.5 Advantages
16.6 Disadvantages
16.7 Conclusion
References
17: Robot-Assisted Thoracic Surgery Thymectomy
17.1 Introduction
17.2 Surgical Anatomy
17.3 Indications
17.4 Procedure
Robotic Thymectomy Via the Subxiphoid Approach
Preparation
Retrosternal Dissection and Pleural Cavity Exploration
Dissection of the Bilateral Upper Poles and Innominate Vein
Dissection of Bilateral Lower Poles
Specimen Retrieval
Advantages of RTX
Easy to Learn
Feasible for Advanced or Large Tumors
Easy to Modify
Feasible for Lymph Node Dissection
Preserves the Intercostal Space and Bundles
Robotic Thymectomy Via the Lateral Approach
17.5 Postoperative Management
17.6 Outcomes of Robotic Thymectomy
17.7 Conclusion
References
18: Non-Conservative Management of Chylothorax
18.1 Introduction
18.2 Anatomy
18.3 Etiology
Traumatic Causes (50%)
Non-Traumatic Causes (45%)
18.4 Diagnosis
18.5 Treatment
Conservative Treatment
Indications
Methods
Prognosis
Interventional Treatment
Indications
Methods
Thoracic Duct Lymphangiography
Thoracic Duct Embolization
Needle Disruption
Transjugular Intrahepatic Portosystemic Stent Shunt
Prognosis
Surgical Treatment
Indications
Surgical Methods
Prognosis
18.6 Conclusion
References
19: Non-Intubated Video-Assisted Thoracic Surgery
19.1 Introduction
19.2 Pathophysiological Changes During NIVATS
19.3 Challenging Indications
19.4 Anesthetic Perspectives
19.5 Surgical Perspectives
19.6 Conclusion
References