Left Uniportal VATS Completion Pneumonectomy for Bronchiectasis

Bronchiectasis is a chronic respiratory disease characterized clinically as a syndrome consisting of cough, sputum production, and bronchial infection and radiologically by abnormal and permanent dilatation of the bronchi. (1)

The objectives of bronchiectasis treatment are to prevent exacerbations, reduce symptoms, improve quality of life, and halt disease progression. Surgical treatment is usually considered an appropriate therapy for bronchiectasis among patients with recurrent exacerbations or refractory disease. (2)

Uniportal video-assisted thoracic surgery (VATS) has a history spanning over more than 10 years and, more recently, has become an increasingly popular approach to manage most of the thoracic surgical diseases. The potential advantages of reduced access trauma, less pain and better cosmesis, together with patient demand, have seen uniportal VATS spread across the world. (3)

A 21-year-old female was hospitalized in our thoracic surgery department with a symptomatology of cough, sputum production, repetitive respiratory infections that started six years before his admission, treated by antibiotic therapy. Having as antecedent a left lower lobectomy by a left posterolateral thoracotomy in 2008 for bronchiectasis, in the pediatric surgery department.

A chest CT scan was requested showing a destroyed left lung with bronchiectasis, hypertrophy of the right lung and delivery of elements from the mediastinum to the left side.

The bronchoscopy objectified a scar of the left lower lobectomy, without visible fistula and reduction of the caliber of the left upper lobar bronchus and thickening of the spurs with the presence of purulent secretions.

On the spirometry results, the FEV was 66%.

The patient was then admitted for a left completion pneumonectomy wich was performed successfully by uniportal VATS approach.

References

1. Polverino E, Goeminne PC, McDonnell MJ, Aliberti S, Marshall SE, Loebinger MR, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J [Internet]. sept 2017
2. Hao X, Dazhong L, Lei Y, Jiaying Z, Linyou Z. Surgical Treatment of Bronchiectasis: 5 Years of Experience at a Single Institution. Journal of Laparoendoscopic & Advanced Surgical Techniques [Internet]. juin 2019
3. Gonzalez-Rivas D. Recent advances in uniportal video-assisted thoracoscopic surgery. Chin J Cancer Res. 2015;27(1):4.

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