Contralateral thoracoscopic lobectomy in postlobectomy patients.

ABSTRACT

BACKGROUND: It is difficult to perform thoracoscopic lobectomy in patients with a history of contralateral lobectomy, as stable oxygenation is not always maintained under conditions of one-lung ventilation during surgery. METHODS: This study evaluated 14 patients who underwent thoracoscopic lobectomy after previously undergoing contralateral lobectomy at a single institution between 2008 and 2015. RESULTS: Among 14 patients who had previously received contralateral lobectomy, 4 were unable to maintain sufficient perioperative oxygenation with usual one-lung ventilation. The predicted pulmonary function before surgery in these patients was as follows both (I) predicted postoperative forced expiratory volume in 1 second <800 mL/m2; and (II) ≤5 contralateral residual segments for ventilation. Regarding special oxygenation techniques, two underwent selective ventilation using lobe-selective bronchial blockade, one underwent intermittent positive airway pressure for operative side lung, and one underwent high-frequency jet ventilation for operative residual lobe. CONCLUSIONS: When performing thoracoscopic lobectomy in patients with a history of contralateral lobectomy, a careful evaluation of the preoperative pulmonary function is needed.