RESUMO
Vascular injury is the most life-threatening complication under thoracoscopic surgery. To reduce the risk of vascular injury, knowledge of the anatomy of the pulmonary artery, variations in its branching, skillful techniques and careful maneuver are necessary. Pulmonary artery being adherent to bronchus is dangerous to dissect under thoracoscopy, so it is better to convert to open thoracotomy. A3 of the left upper lobe is occasionally injured during dissection. It is a safety technique for using vascular stapler under thoracoscopic surgery. Stapler leader can allow the passage of a stapler to encircle the vessel.
Assuntos
Hemorragia/cirurgia , Complicações Intraoperatórias/cirurgia , Pneumonectomia/métodos , Nódulo Pulmonar Solitário/cirurgia , Toracoscopia/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Pulmonar , Aderências Teciduais/cirurgia , Doenças Vasculares/cirurgiaRESUMO
Early peripheral lung cancer is defined as a tumor whose diameter is within 20 mm and that has not metastasized to lymph nodes. We developed thoracoscopic surgery (two windows method) in 1993. We have been conducting this thoracoscopic surgery in early peripheral lung cancers to identify possible indications as well as to clarify problems related to early peripheral lung cancer. The subjects of this study were 176 tumors, with diameters within 30 mm, including 97 lung cancers with diameters within 20 mm. Of the 97 tumors 20 mm or less in diameter, 18 were N 1 or more severe (N 1, 8 cases: N 2, 10 cases). One patient (N 2) died of bone metastasis and two patients died due to diseases other than lung cancer. Nearly 20% of the patients with tumors 20 mm or less were in the advanced stage, suggesting that mediastinal lymph node resection is necessary. Based on these results, it is advisable to define tumors with a diameter of no more than 10 mm as early peripheral lung cancer.
