Article Abstract

Microlobectomy: completely portal pulmonary lobectomy

Authors: Marco Nardini, Rocco Bilancia, Piergiorgio Solli, Shruti Jayakumar, Ian Paul, Marcello Migliore, Joel Dunning

Abstract

Background: Video assisted pulmonary lobectomy is 25 years old. Despite the recent advancement of minimally invasive surgery, this procedure is still related to a considerable amount of post-operative pain. We describe the results with ‘Microlobectomy’: an innovative technique which eliminated the utility port.
Methods: Microlobectomy has been offered at James Cook University Hospital, UK, for the last 4 years. This manuscript represents a single centre, single surgeon consecutive series of cases from January 2014 until December 2016. The technique was recently described in a multi-center study. Its key principles are: no intercostal incisions larger than 5 mm, no utility incision, a 12 mm subxiphoid port (used for specimen retrieval and chest drainage), CO2 insufflation of the surgical field throughout the procedure, 5 mm diameter instruments and 5 mm optic are adopted. We offered this procedure to all the patients awaiting pulmonary lobectomy for different conditions, while relative contraindications were severe obesity and left ventricular hypertrophy for left sided procedure.
Results: Data from 82 cases where recorded. Mean age was 66 years (range, 27–82 years). Sixty-nine operations (84.1%) were performed for pulmonary malignancy (stages from Ia to IIIb). Fifty-three patients underwent a right sided procedure and 29 a left sided, namely the procedures were: 30 right upper lobectomies, 9 right middle, 13 right lower, 15 left upper, 7 left lower, 4 trisegmentectomy, 2 lingulectomy, 1 right and 1 left pneumonectomy. Conversion rate was 3.7% (3 patients). The mean operative time was 189 minutes (range, 126–315 minutes). The 30 days mortality was 1.2% (1 patient deceased of sepsis). Morbidity was post-operative infection in 12 individuals (14.6%), atrial fibrillation in 3 (3.7%) and prolonged air leakage, over 5 days, in 9 (11%). Seventeen patients (20.7%) went home on the day after surgery, 31 (37.8%) went home on post-operative day 2. Sixty-three patients (76.8%) went home within the first week from the procedure. The median length of stay was 3 days (range, 1–34 days).
Conclusions: We are enthusiast about these preliminary results and we will continue to offer this procedure in order to report on a wider cohort and also to have long term oncological follow up data.