Ingenuity of minimally invasive thoracoscopic lobectomy for undiagnosed pulmonary tumour

• Published in: Respirology case reports 2020-10, Vol.8 (7), p.e0657-n/a
• Main Authors: Yamanaka, Sumitaka, Yoshimatsu, Takashi, Miyata, Takeaki, Higa, Hanae
• Format: Article
• Language: English
• Subjects: Biopsy; Case Report; Case Reports; Endoscopy; Intercostal nerve; Lung cancer; neuralgia; Ostomy; Pain; Patients; Quality of life; reduced port surgery; Thoracic surgery; tuberculosis; video‐assisted thoracic surgery
• ISSN: 2051-3380; 2051-3380
• DOI: 10.1002/rcr2.657

A 51‐year‐old man was referred to our hospital, with a dumbbell‐shaped nodule measuring 40 mm in the right upper lobe of the lung. He was a current smoker with diabetes mellitus and bronchial asthma. The transbronchial biopsy was performed. However, definitive diagnosis was not obtained from the excised specimens. Bacterial culture of bronchial lavage fluid also yielded negative results, including for tuberculosis. After eight months of observation, the tumour had slightly increased in size. Surgery was planned to resect the tumour for definitive diagnosis. Because of the size of the tumour, a lobectomy of the lung was scheduled with the patient's consent. Four small incisions, each less than 1.2 cm long, were made in the chest wall for thoracoscopic surgery. To remove the specimen, we made a 3‐cm longitudinal incision 1 cm below the xiphisternal joint. The patient complained of no chest pain after surgery. The post‐operative course was uneventful. This study describes video‐assisted thoracic surgery (VATS) with minimal chest incisions to prevent chronic post‐operative intercostal neuralgia and paraesthesia, using a small subxiphoid incision only to remove the specimen.