Thoracoscopic Lobectomy with Chest Wall Resection
Chumy Nwogu, Sai Yendamuri, Todd Demmy.
Roswell Park Cancer Institute, SUNY, Buffalo, NY, Buffalo, NY, USA.
BACKGROUND:
Associated chest wall resection is considered a contraindication to thoracoscopic pulmonary resection. However, new instruments have made this procedure feasible. This video presentation demonstrates the technique of a thoracoscopic chest wall resection with anatomic pulmonary resection.
METHODS:
A 69 year old male presented with a right upper lobe mass invading the chest wall. CT/PET showed regional disease. He received neoadjuvant concurrent platin-based chemoradiation for non-small cell lung cancer.
RESULTS:
Modest response, lack of distant disease on PET and a favorable mediastinoscopy led to surgical resection. An en bloc, thoracoscopic right upper lobectomy with resection of segments of the 3rd, 4th and 5th ribs was successfully performed using 2 ports and a 4cm access incision. An endoscopic bone cutter and a 5 mm Ligasure device (Valley Lab Inc, Boulder, CO) facilitated the procedure. His post-operative course was complicated by a hemothorax which was evacuated thoracoscopically. This was attributed to anti-platelet and heparin therapy since no surgical bleeding was found. He was discharged on post-operative day 9. He tolerated adjuvant chemotherapy well and three weeks post-operatively had stopped all narcotics and had no activity limitations.
CONCLUSIONS:
This is the first report demonstrating that a thoracoscopic chest wall resection can be performed safely in carefully selected patients with lung cancer invading the chest wall. This procedure has the potential of lowering the morbidity of chest wall resections especially in frail patients.
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