Objective: Few reports have been seen on VATS lobectomy for pulmonary aspergyllosis that usually affects already sick patients who usually require as minimally invasive treatments as possible. We performed VATS lobectomies in the patients with this condition and evaluate the feasibility of the procedure.
Methods: Three-port VATS lobectomy was performed in 11 pulmonary aspergyllosis patients since May 2001 to June 2006 who have aspergyllomas with infections limited to one lobe of the lung. There were 7 men and 4 women with the age of 31 to 78 (mean 59). Their major co-morbidity include DM in 4, leukemia in 2, old tuberculosis in 2 and previous ARDS in 1. All the procedures were done through three ports (7, 10 and 25 mm). Twenty five millimeters incision was made longer up to 4 cm when the lobe was taken out of the chest cavity.
Results: There was one death from sepsis following bronchial dehiscence in the patient with DM, liver cirrhosis and previous esophageal cancer surgery. The operation time ranged from 140 to 475 minutes (mean 186, median 164). The blood loss ranged from 40 to 1250 ml (mean 228, median 125). All the adhesion between the lung and the chest wall could be lysed with three ports VATS approach. Anatomic lobectomies were completed in 9 patients. The pulmonary artery could not be separated from the bronchus in 2 patients and the simultaneous stapling method was applied in these cases.
Conclusions: Patients with the history of esophageal cancer surgery may not be a good candidate for the procedure because of the poor blood supply to the bronchus. Three ports VATS lobectomy could be one of the options for the patients with pulmonary aspergyllosis in selected patients.