Contralateral thoracoscopic lobectomy in postlobectomy patients

• Published in: Journal of thoracic disease Vol. 9; no. 9; pp. 3187 - 3192
• Main Authors: Yasuda, Manabu, Nakanishi, Ryoichi, Shinohara, Shinji, Mori, Masataka, Ashikari, Syuhei, Oyama, Tsunehiro, Hanagiri, Takeshi
• Format: Journal Article
• Language: English
• Published: China AME Publishing Company 01.09.2017
• Subjects: Original; special oxygenation technique; Thoracoscopic lobectomy; predicted postoperative lung function
• ISSN: 2072-1439; 2077-6624
• DOI: 10.21037/jtd.2017.08.107

It is difficult to perform thoracoscopic lobectomy in patients with a history of contralateral lobectomy, as stable oxygenation is not always maintained under conditions of one-lung ventilation during surgery. This study evaluated 14 patients who underwent thoracoscopic lobectomy after previously undergoing contralateral lobectomy at a single institution between 2008 and 2015. Among 14 patients who had previously received contralateral lobectomy, 4 were unable to maintain sufficient perioperative oxygenation with usual one-lung ventilation. The predicted pulmonary function before surgery in these patients was as follows: both (I) predicted postoperative forced expiratory volume in 1 second <800 mL/m ; and (II) ≤5 contralateral residual segments for ventilation. Regarding special oxygenation techniques, two underwent selective ventilation using lobe-selective bronchial blockade, one underwent intermittent positive airway pressure for operative side lung, and one underwent high-frequency jet ventilation for operative residual lobe. When performing thoracoscopic lobectomy in patients with a history of contralateral lobectomy, a careful evaluation of the preoperative pulmonary function is needed.