title: Initial experience with video-assisted thoracoscopic bronchoplasty.
abstract: OBJECTIVE
  Bronchial-origin involvement by endobronchial tumours or direct invasion by tumour or metastatic lymph nodes is a relative contraindication for video-assisted thoracoscopic (VATS) lobectomy. However, selected cases can be resected by VATS bronchoplasty.
  
  
  METHODS
  Between 2006 and 2009, 21 of 231 (9.1%) VATS lobectomy cases underwent VATS bronchoplasty. Cases with endobronchial involvement and limited non-bulky invasion of bronchus by tumour or metastatic nodes without major vascular invasion were selected for bronchoplasty by preoperative bronchosocpy and CT scan thorax. Patients underwent a simple/wedge bronchoplasty (bronchus divided at origin and closed flush or transversely), sleeve bronchoplasty or others (bronchoplasty combined with other extended resections). All bronchoplasties were done totally endoscopically by directly watching a TV monitor. Bronchial margins were all subjected to intraoperative pathological analysis. Anastomosis was done with interrupted sutures. Integrity of anastomosis was checked by intraoperative bronchoscopy. The follow-up was done by 6-monthly CT scans and bronchoscopy.
  
  
  RESULTS
  Eleven patients were females. Mean age was 64.9 years (range, 47-83 years). Indications were endobronchial tumours in 3, direct invasion in 6 and metastatic nodes in 12. In 4 cases, invasion was detected at the time of surgery. Mean hospital stay was 5.2 days (range, 3-8 days). Mean duration of surgery was 287 min (range, 135-540 min). Nine had simple/wedge bronchoplasty, 8, sleeve bronchoplasty and 4, extended bronchoplasties. Histology was non-small-cell carcinoma (NSCLC) in 19, carcinoid in 1 and colonic metastasis in 1. In the NSCLC, 5 patients were in stage IB, 5 in stage IIA, 2 in stage IIB and 7 were in IIIA. All bronchial margins were negative for malignancy. The mean follow-up was 26.2 months (range, 6-32 months). There was no operative mortality, but 1 patient developed bronchopleural fistula. To date, there have been no local tumour recurrences.
  
  
  CONCLUSIONS
  Selected endobronchial and non bulky tumours with limited invasion at bronchial origin can be resected by VATS bronchoplasty.
authors.affiliation: National University Hospital, National University of Singapore, Singapore.
authors.forename: Thirugnanam
authors.initials: T
authors.lastname: Agasthian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi / Q000601:surgery*; D001984:Bronchial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation / Q000379:methods*
keywords: Bronchoplasty; Thoracoscopy/VATS