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Philippe RINIERI

Hôpital Charles Nicolle
Rouen, France
MD
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Right upper lobectomy for large apical tuberculosis cavity using videothoracoscopy: focus on the use of curved endoscopic instruments
A 36-year-old patient was treated for tuberculosis for two years in Georgia. However, treatment failed. After a 3-month treatment in France, CT-scan showed a persistent tuberculous cavity in the right upper lobe, which seemed totally destroyed, associated with bilateral opacities. The patient was still multi-bacillary. A right upper lobectomy by videothoracoscopy was performed. Dissection of the right upper lobe, fully retracted on the apex, was facilitated by the use of an ENSEAL® G2 articulating tissue sealer (Ethicon Endosurgery), a curved vacuum, and the ENDOEYE FLEX 3D (Olympus) articulated camera. The ENSEAL® articulated bipolar forceps facilitated the perpendicular approach to the superior lobar vessels, which were all sheathed by inflamed tissues, and improved dissection of retractile adhesions to the pulmonary apex and mediastinum. It made the handling of hemorrhagic tissue easier. The 3D camera allowed an accurate visualization of these complex anatomical relationships. Drains were removed on postoperative day 6. The BK sputum was negative postoperatively and at 5 months. CT-scan at 2 months is satisfactory with a regression of bilateral opacities. Videothoracoscopy using articulated endoscopic instruments is a relevant technique for the resection of tuberculous lesions, even when lesions are large and retractile.
L Haddad, J Melki, P Rinieri, C Peillon, JM Baste
Surgical intervention
3 years ago
968 views
36 likes
0 comments
07:35
Right upper lobectomy for large apical tuberculosis cavity using videothoracoscopy: focus on the use of curved endoscopic instruments
A 36-year-old patient was treated for tuberculosis for two years in Georgia. However, treatment failed. After a 3-month treatment in France, CT-scan showed a persistent tuberculous cavity in the right upper lobe, which seemed totally destroyed, associated with bilateral opacities. The patient was still multi-bacillary. A right upper lobectomy by videothoracoscopy was performed. Dissection of the right upper lobe, fully retracted on the apex, was facilitated by the use of an ENSEAL® G2 articulating tissue sealer (Ethicon Endosurgery), a curved vacuum, and the ENDOEYE FLEX 3D (Olympus) articulated camera. The ENSEAL® articulated bipolar forceps facilitated the perpendicular approach to the superior lobar vessels, which were all sheathed by inflamed tissues, and improved dissection of retractile adhesions to the pulmonary apex and mediastinum. It made the handling of hemorrhagic tissue easier. The 3D camera allowed an accurate visualization of these complex anatomical relationships. Drains were removed on postoperative day 6. The BK sputum was negative postoperatively and at 5 months. CT-scan at 2 months is satisfactory with a regression of bilateral opacities. Videothoracoscopy using articulated endoscopic instruments is a relevant technique for the resection of tuberculous lesions, even when lesions are large and retractile.
Video-assisted thoracic surgery (VATS): middle lower bilobectomy with lymph nodes dissection for carcinoid tumor
Objective
Carcinoid tumors represent less than 5% of the bronchopulmonary cancers [1], but often concern young people. A lung-sparing anatomical resection is often preferred if possible [2]. However, an uneasy intrabronchial localization mandates a major resection such as bilobectomy and/or sometimes pneumonectomy for complete resection as it is the aim of carcinoid tumor treatment. This can be achieved using a minimally invasive approach [3, 4].
Case presentation
This is the case of a 34-year-old woman suffering from recurrent right pneumopathy, without any other medical history. A mass in the middle lobe bronchus with partial obstruction of the intermedius bronchus was found on CT-scan. Bronchoscopy found the extension of a strawberry-like tumor until segment 6 bronchus. Histopathology confirmed the presence of a carcinoid tumor. A radical excision with middle lower bilobectomy by VATS was decided upon rather than middle lobe sleeve lobectomy in order to ensure complete resection.
Results
There was no postoperative complication and the patient was discharged on postoperative day 5. The operative specimen contained the tumor. Vascular and bronchial resections were free. Histopathology confirmed a typical pT1N0 carcinoid tumor.
Conclusion
Complete middle lower bilobectomy can be performed using a VATS approach. This therapeutic option seems worthwhile in young people because of low postoperative morbidity and fast recovery for active people.

Bibliographic references
1. Fink G, Krelbaum T, Yellin A, Bendayan D, Saute M, Glazer M, Kramer MR. Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature. Chest 2001;119:1647-51.
2. Schrevens L, Vansteenkiste J, Deneffe G, De Leyn P, Verbeken E, Vandenberghe T, Demedts M. Clinical-radiological presentation and outcome of surgically treated pulmonary carcinoid tumours: a long-term single institution experience. Lung Cancer 2004;43:39-45.
3. Hansen HJ, Petersen RH, Christensen M. Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach. Lung Cancer 2011;71,25(4):1263-9.
4. Walker WS, Codispoti M, Soon SY, Stamenkovic S, Carnochan F, Pugh G. Long-term outcomes following VATS lobectomy for non-small cell bronchogenic carcinoma. Eur J Cardiothoracic Surg 2003;23:397-402.
JM Baste, P Rinieri, A Sebestyen
Surgical intervention
5 years ago
1225 views
19 likes
0 comments
07:26
Video-assisted thoracic surgery (VATS): middle lower bilobectomy with lymph nodes dissection for carcinoid tumor
Objective
Carcinoid tumors represent less than 5% of the bronchopulmonary cancers [1], but often concern young people. A lung-sparing anatomical resection is often preferred if possible [2]. However, an uneasy intrabronchial localization mandates a major resection such as bilobectomy and/or sometimes pneumonectomy for complete resection as it is the aim of carcinoid tumor treatment. This can be achieved using a minimally invasive approach [3, 4].
Case presentation
This is the case of a 34-year-old woman suffering from recurrent right pneumopathy, without any other medical history. A mass in the middle lobe bronchus with partial obstruction of the intermedius bronchus was found on CT-scan. Bronchoscopy found the extension of a strawberry-like tumor until segment 6 bronchus. Histopathology confirmed the presence of a carcinoid tumor. A radical excision with middle lower bilobectomy by VATS was decided upon rather than middle lobe sleeve lobectomy in order to ensure complete resection.
Results
There was no postoperative complication and the patient was discharged on postoperative day 5. The operative specimen contained the tumor. Vascular and bronchial resections were free. Histopathology confirmed a typical pT1N0 carcinoid tumor.
Conclusion
Complete middle lower bilobectomy can be performed using a VATS approach. This therapeutic option seems worthwhile in young people because of low postoperative morbidity and fast recovery for active people.

Bibliographic references
1. Fink G, Krelbaum T, Yellin A, Bendayan D, Saute M, Glazer M, Kramer MR. Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature. Chest 2001;119:1647-51.
2. Schrevens L, Vansteenkiste J, Deneffe G, De Leyn P, Verbeken E, Vandenberghe T, Demedts M. Clinical-radiological presentation and outcome of surgically treated pulmonary carcinoid tumours: a long-term single institution experience. Lung Cancer 2004;43:39-45.
3. Hansen HJ, Petersen RH, Christensen M. Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach. Lung Cancer 2011;71,25(4):1263-9.
4. Walker WS, Codispoti M, Soon SY, Stamenkovic S, Carnochan F, Pugh G. Long-term outcomes following VATS lobectomy for non-small cell bronchogenic carcinoma. Eur J Cardiothoracic Surg 2003;23:397-402.
Full endoscopic robot-assisted basal segmentectomy for bronchiectasis
Objective
Surgical treatment of bronchiectasis is often proposed in complicated situations [1]. The development of minimally invasive surgery should allow us to propose a surgical curative treatment with preventative purposes. In this video, we describe a lung-sparing surgery using a full endoscopic robotic segmentectomy as described by Dylewsky [2] to deal with localized bronchiectasis.
Case presentation
This is the case of a 40-year-old man with bronchiectasis, colonized by Pseudomonas aeruginosa with antibiotic resistance. The patient suffered from recurrent infections. Bronchiectasis is localized in the left basal segments on CT-scan. Basal segmentectomy was decided upon using a robot-assisted procedure. This kind of patient is usually treated medically with iterative antibiotherapy until a new complication occurs.
Results
There was no postoperative complication and the patient was discharged on postoperative day 4. The patient resumed work after one month without any complaint.
Conclusion
When using a precise resection, basal segmentectomy seems to be feasible using a robot-assisted procedure, without increasing perioperative morbidity. This procedure should be proposed as a preventative surgery as it is a relatively new approach for benign or infectious lung disease.
Bibliographic references
1. Agasthian T. Results of surgery for bronchiectasis and pulmonary abscesses. Thorac Surg Clin. 2012;22:333-44.
2. Dylewski MR, Ohaeto AC, Pereira JF. Pulmonary resection using a total endoscopic robotic video-assisted approach. Semin Thorac Cardiovasc Surg. 2011;23:36-42.
JM Baste, P Rinieri, A Sebestyen
Surgical intervention
5 years ago
278 views
4 likes
0 comments
07:42
Full endoscopic robot-assisted basal segmentectomy for bronchiectasis
Objective
Surgical treatment of bronchiectasis is often proposed in complicated situations [1]. The development of minimally invasive surgery should allow us to propose a surgical curative treatment with preventative purposes. In this video, we describe a lung-sparing surgery using a full endoscopic robotic segmentectomy as described by Dylewsky [2] to deal with localized bronchiectasis.
Case presentation
This is the case of a 40-year-old man with bronchiectasis, colonized by Pseudomonas aeruginosa with antibiotic resistance. The patient suffered from recurrent infections. Bronchiectasis is localized in the left basal segments on CT-scan. Basal segmentectomy was decided upon using a robot-assisted procedure. This kind of patient is usually treated medically with iterative antibiotherapy until a new complication occurs.
Results
There was no postoperative complication and the patient was discharged on postoperative day 4. The patient resumed work after one month without any complaint.
Conclusion
When using a precise resection, basal segmentectomy seems to be feasible using a robot-assisted procedure, without increasing perioperative morbidity. This procedure should be proposed as a preventative surgery as it is a relatively new approach for benign or infectious lung disease.
Bibliographic references
1. Agasthian T. Results of surgery for bronchiectasis and pulmonary abscesses. Thorac Surg Clin. 2012;22:333-44.
2. Dylewski MR, Ohaeto AC, Pereira JF. Pulmonary resection using a total endoscopic robotic video-assisted approach. Semin Thorac Cardiovasc Surg. 2011;23:36-42.