Uniportal VATS combined subsegmentectomy of the left S1+2c+S3a guided by 3D computed tomography simulation.

When a tumor to be resected is located close to or extending beyond the intersegmental plane, combined segmentectomy or subsegmentectomy is an option to ensure a sufficient surgical margin. The segmental and subsegmental anatomy of the lungs varies greatly from case to case. Therefore, there is no standardized procedure for combined subsegmentectomy, and surgical planning based on individual anatomy using three-dimensional computed tomography is essential. This video tutorial presents the surgical technique for uniportal video-assisted thoracic surgery of the left S1+2c+S3a combined subsegmentectomy for tumors located at the border of the S1+2c and S3a segments of the left upper lobes, with preoperative three-dimensional simulation and intraoperative navigation images.

Successfully treated bronchopulmonary oxalosis caused by Aspergillus tubingensis in a non-neutropenic patient: A case report and review of the literature.

Pulmonary oxalosis can be fatal, and Aspergillus tubingensis is commonly resistant to azoles in Japan. We report a case of bronchopulmonary oxalosis caused by A. tubingensis in a non-neutropenic patient who was successfully treated with voriconazole monotherapy. The susceptibility of the isolates to voriconazole and the effective elimination of contagious necrotic tissue by expectoration seemed to be two major factors contributing to the patient's survival. According to the literature review, pulmonary oxalosis is associated with a high mortality rate over a short term. An exploration of detailed information about the genomic characteristics and drug susceptibility of Aspergillus isolates is important for the development of treatment strategies for this life-threatening disease.

A case of juvenile primary pulmonary malignant fibrous histiocytoma.

An 18-year-old female presented with an abnormal shadow of a 22-mm nodule in the left anterior segment of the upper lung lobe (S3) on chest X-ray and computed tomography (CT). Thoracoscopic partial lobectomy was performed, when a frozen section suggested spindle cell sarcoma of extrapulmonary origin, including malignant fibrous histiocytoma (MFH). A histologic diagnosis of the MFH was rendered postoperatively on permanent sections. As no other primary focus was detected in spite of intensive investigation, including 18F-fluorodeoxyglucose positron emission tomography - CT scans, a definitive diagnosis was made of primary pulmonary MFH. Primary pulmonary MFH is usually treated by total resection, however, in the current case we performed a partial lobectomy with clear margins and a watchful follow-up without any additional aggressive treatment. No relapse has been observed for 3 years after the surgery.

Lobectomy of second primary cancer in survivor of small cell lung cancer with brain metastasis.

Resection of a second primary nonsmall cell lung carcinoma in a long-term survivor of small cell lung carcinoma with brain metastasis is reported. The patient had squamous cell carcinoma as the second primary tumor and underwent lobectomy with node dissection. He was alive 79 months after the initial diagnosis of the small cell carcinoma, 64 months after the diagnosis of the brain metastasis, and 21 months after the curative pulmonary resection for his second primary carcinoma.

Video-assisted thoracoscopic surgery in treatment of stabbing chest injuries.

Since 1994, we have performed video-assisted thoracoscopic surgery in order to treat thoracic trauma. In general, emergency surgery is performed for trauma injuries incurred by knives. Between 1994 and 2005, we performed thoracoscopic surgery on eighteen cases of thoracic stab wounds. Among these eighteen cases, two were characterized by wounds to the internal thoracic artery, and they had to be switched over to open thoracotomy due to excessive bleeding. In conclusion, open thoracotomy should be performed in cases in which the patient is in a state of shock due to severe intrathoracic bleeding; however, in cases in which the vital signs are stable, thoracoscopic surgery may be carried out to stop intrathoracic bleeding, to repair the lung injury by suturing, as well as by performing a partial resection of the lung.

Video-assisted thoracoscopic surgery under local anesthesia for right empyema secondary to aspiration pneumonia caused by esophageal achalasia: case report.

A 55-year-old man was admitted to the Department of Internal Medicine of our hospital with chief complaints of fever, cough, and right-sided chest pain. Plain radiography of the chest revealed widening of the mediastinum (attributed to esophageal achalasia), pneumonia, and right pleural effusion. According to the properties of the pleural fluid, empyema was diagnosed. Because the empyema was resistant to antibiotic treatment and was in the fibrinopurulent stage, it could not be drained effectively. Therefore, after treatment of the esophageal achalasia by balloon dilatation of the lower esophagus, the empyema was treated by video-assisted thoracoscopic surgery, i.e., by video-assisted thoracoscopic drainage and curettage of the empyema cavity, under local anesthesia.