Techniques in Minimally Invasive Thoracic Surgery

Description

This book provides a guide to the surgical techniques required in thoracic surgery. Minimally invasive surgery (MIS) has become a standard surgical technique in the field of thoracic surgery recently. In addition, the evolution of video equipment and surgical instruments, and robotic devices lead to the rapid development of surgical techniques. Providing the latest and detailed surgical techniques and reviews of video-assisted thoracic surgery and robotic surgery in commonly performed thoracic surgery, and is expected to be of great help to general, thoracic, cardiothoracic, and cardiovascular surgeon who starts minimally invasive 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