June 14, 2017

VATS Pneumonectomy: An Up-Close Video Look

Watch the minimally invasive approach to this lung cancer case

A 67-year-old female never-smoker presented with recurrent upper respiratory tract infections requiring repeated hospitalizations. After bronchoscopy at an outside hospital revealed an obstructive mass in the distal left main bronchus, she was transferred to Cleveland Clinic for further evaluation.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Lung CT revealed a mass at the distal left main bifurcation leading to obstructive atelectasis of the upper lobe. Bronchoscopy at Cleveland Clinic confirmed the earlier findings, and aggressive debridement revealed a typical carcinoid neoplasm. Bronchial ultrasound assessment of the paratracheal lymph nodes found no evidence of neoplasm. Extension of the tumor down the upper and lower lobe segmental bronchi, including direct involvement of the secondary carina, ruled out sleeve resection.

Preoperative evaluation revealed an FEV1 of 1.05 (49 percent predicted) and a DLCO of 13.98 (70 percent predicted). Quantitative perfusion scan showed only 10 percent perfusion to the left lung. Stress echocardiogram revealed a fixed defect in the inferior wall with no inducible ischemia and a normal ejection fraction.

The clinical team decided to proceed with left pneumonectomy using a planned video-assisted thoracoscopic surgery (VATS) approach. In the narrated six-minute intraoperative video below, Daniel Raymond, MD, of Cleveland Clinic’s Department of Thoracic and Cardiovascular Surgery, walks clinicians through essential points in the operation after an animation showing the surgical plan.

Advertisement

Related Articles

intraoperative photo of robotic tracheobronchoplasty
June 22, 2023
Robotically Assisted Tracheobronchoplasty: A Case Study

Excessive dynamic airway collapse presenting as dyspnea and exercise intolerance in a 67-year-old

23-HVI-3766948 CQD 650×450
May 24, 2023
Case Report: 3-Month Journey From Health to Multiorgan Transplant to Discharge

Young man saved multiple times by rapid collaborative response

22-HVI-2987079 CQD 650×450
September 28, 2022
Off-Label Endovascular Intervention for Giant Aortic Arch Aneurysm: A Case Study

Necessity breeds innovation when patient doesn’t qualify for standard treatment or trials

22-HVI-3200903 CQD 650×450
September 13, 2022
Case Study: A Young Man With Nonischemic Cardiomyopathy and Uncontrolled VT

After optimized medical and device therapy, is there a role for endocardial-epicardial VT ablation?

22-HVI-2958608-1 650×450
June 14, 2022
When the Ross Procedure Fails: Fifth Operation Offers Young Man a New Start

Fever and aortic root bleeding two decades post-Ross procedure

21-HVI-2595510_aortic-aneurysm_650x450
March 18, 2022
Case Study: When Lung Transplant Evaluation Reveals a Large Abdominal Aortic Aneurysm

How to time the interventions, and how to manage anesthesia risks?

21-HVI-2128310-CQD-Complex-Reoperative-Case-Ross-Procedure-H1
June 3, 2021
The Ross Procedure in a Reoperative Setting: A Case Study

A potentially definitive repair in a young woman with multiple prior surgeries

20-HVI-2029540_Bypass5_Hero
December 29, 2020
MIDCAB: A Case Study in Its Benefits, Considerations for Patient Selection

Matching the minimally invasive CABG alternative to the right candidates

Ad