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Thorsten KRUEGER

CHUV
Lausanne, Switzerland
MD
219 likes
7310 views
2 comments
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VATS right upper lobectomy with en bloc chest wall resection
The optimal treatment of lung cancer invading the chest wall is complete surgical resection via lobectomy and en bloc chest wall resection, which has a 40 to 50% 5-year survival when there is no lymph node involvement.
VATS lobectomy is currently preferred as a standard approach in selected cases for pulmonary resections, especially for early stage non-small cell lung cancer with acceptable safety, successful surgical outcomes, and oncological efficacy. With recent advances in both equipment and technique, VATS is being applied to more complex conditions by some experienced thoracic surgeons.
We present the case of a 68-year-old man with pulmonary squamous cells carcinoma of the right upper lobe invading chest wall on the level of posterolateral part of the 3rd and 4th ribs. Right upper lobectomy with en bloc chest wall resection was finally performed by VATS.
M Gonzalez, JY Perentes, T Krueger
Surgical intervention
3 years ago
1030 views
40 likes
1 comment
12:29
VATS right upper lobectomy with en bloc chest wall resection
The optimal treatment of lung cancer invading the chest wall is complete surgical resection via lobectomy and en bloc chest wall resection, which has a 40 to 50% 5-year survival when there is no lymph node involvement.
VATS lobectomy is currently preferred as a standard approach in selected cases for pulmonary resections, especially for early stage non-small cell lung cancer with acceptable safety, successful surgical outcomes, and oncological efficacy. With recent advances in both equipment and technique, VATS is being applied to more complex conditions by some experienced thoracic surgeons.
We present the case of a 68-year-old man with pulmonary squamous cells carcinoma of the right upper lobe invading chest wall on the level of posterolateral part of the 3rd and 4th ribs. Right upper lobectomy with en bloc chest wall resection was finally performed by VATS.
Video-assisted thoracoscopic surgery (VATS): Right middle lobectomy and complete mediastinal lymphadenectomy
The surgical management of non-small cell lung cancer (NSCLC) involves anatomical lung resection and systematic mediastinal lymph node dissection.
Video-assisted thoracic surgery (VATS) lobectomy for early NSCLC is actually preferred over a thoracotomy in experienced centers.
Potential advantages described of VATS lobectomy are decreased postoperative pain, less blood loss, shortened hospital length of stay, fewer overall complications, diminished immunologic suppression, as well as an increased ability to deliver adjuvant therapy. Oncological results are at least equivalent as thoracotomy in terms of long-term recurrence and survival rates.
We present the case of a 63-year-old woman with clinical cT2 cN0 lung adenocarcinoma of the middle lobe. The patient underwent right middle lobectomy with complete mediastinal lymph node dissection using an anterior three-port thoracoscopic approach.
M Gonzalez, T Krueger, JY Perentes
Surgical intervention
4 years ago
1676 views
41 likes
0 comments
10:42
Video-assisted thoracoscopic surgery (VATS): Right middle lobectomy and complete mediastinal lymphadenectomy
The surgical management of non-small cell lung cancer (NSCLC) involves anatomical lung resection and systematic mediastinal lymph node dissection.
Video-assisted thoracic surgery (VATS) lobectomy for early NSCLC is actually preferred over a thoracotomy in experienced centers.
Potential advantages described of VATS lobectomy are decreased postoperative pain, less blood loss, shortened hospital length of stay, fewer overall complications, diminished immunologic suppression, as well as an increased ability to deliver adjuvant therapy. Oncological results are at least equivalent as thoracotomy in terms of long-term recurrence and survival rates.
We present the case of a 63-year-old woman with clinical cT2 cN0 lung adenocarcinoma of the middle lobe. The patient underwent right middle lobectomy with complete mediastinal lymph node dissection using an anterior three-port thoracoscopic approach.
Video-assisted thoracoscopic surgery (VATS): left upper lobectomy and complete lymphadenectomy by fissureless anterior approach
The surgical management of non-small cell lung cancer (NSCLC) involves anatomical lung resection and systematic mediastinal lymph node dissection.
Video-assisted thoracic surgery (VATS) lobectomy for early NSCLC is currently preferred over a thoracotomy in experienced centers.
Possible advantages described of VATS lobectomy are decreased postoperative pain, less blood loss, shortened hospital stay, fewer overall complications, diminished immunologic suppression, as well as an increased ability to deliver adjuvant therapy. Oncological results are at least equivalent as thoracotomy in terms of long-term recurrence and survival rates.
We present the case of a 58-year-old woman with suspicion of peripheral pulmonary cT1 cN0 cancer who initially underwent wedge resection by VATS of the lesion with preoperative localization using a CT-guided hook wire. Frozen section revealed the presence of squamous cell carcinoma, and completion lobectomy with complete mediastinal lymph node dissection was finally performed by VATS.
M Gonzalez, JY Perentes, T Krueger
Surgical intervention
4 years ago
1637 views
34 likes
0 comments
10:43
Video-assisted thoracoscopic surgery (VATS): left upper lobectomy and complete lymphadenectomy by fissureless anterior approach
The surgical management of non-small cell lung cancer (NSCLC) involves anatomical lung resection and systematic mediastinal lymph node dissection.
Video-assisted thoracic surgery (VATS) lobectomy for early NSCLC is currently preferred over a thoracotomy in experienced centers.
Possible advantages described of VATS lobectomy are decreased postoperative pain, less blood loss, shortened hospital stay, fewer overall complications, diminished immunologic suppression, as well as an increased ability to deliver adjuvant therapy. Oncological results are at least equivalent as thoracotomy in terms of long-term recurrence and survival rates.
We present the case of a 58-year-old woman with suspicion of peripheral pulmonary cT1 cN0 cancer who initially underwent wedge resection by VATS of the lesion with preoperative localization using a CT-guided hook wire. Frozen section revealed the presence of squamous cell carcinoma, and completion lobectomy with complete mediastinal lymph node dissection was finally performed by VATS.
Thoracoscopic management of empyema
From the mid-1990s, thoracoscopic treatment of empyemas has gained a wide acceptance. Potential advantages of video-assisted thoracoscopic surgery (VATS) include improved visualization, less surgical trauma and improved quality of life. VATS was initially used in early stage empyema to debride purulent collections and resect fibrin septae that failed to resolve with antibiotics and chest tube drainage (with or without fibrinolytic therapy).
The goals of the thoracoscopic treatment of empyema are as follows: 1) the debridement of purulent collections and fibrin, 2) the evacuation of necrotic material, 3) the breakdown of loculations, 4) to obtain adequate lung re-expansion, and 5) optimal chest tube placement for drainage.
Several reports have demonstrated that VATS debridement is a valid treatment option for stage II empyema, which allows an appropriate control of infection and a complete restoration of pulmonary function in early stage empyemas. Formal exclusion criteria for a primary VATS approach are suspicion of lung abscess, bronchopleural fistula, tumor at initial work-up or the need of muscle flaps with or without thoracoplasty. Presumed stage III empyema with pleural thickening and signs of restriction on CT-scan no longer are formal contraindications, but the conversion rate to decortications via thoracotomy is higher.
M Gonzalez, JY Perentes, T Krueger
Surgical intervention
5 years ago
2969 views
104 likes
1 comment
07:09
Thoracoscopic management of empyema
From the mid-1990s, thoracoscopic treatment of empyemas has gained a wide acceptance. Potential advantages of video-assisted thoracoscopic surgery (VATS) include improved visualization, less surgical trauma and improved quality of life. VATS was initially used in early stage empyema to debride purulent collections and resect fibrin septae that failed to resolve with antibiotics and chest tube drainage (with or without fibrinolytic therapy).
The goals of the thoracoscopic treatment of empyema are as follows: 1) the debridement of purulent collections and fibrin, 2) the evacuation of necrotic material, 3) the breakdown of loculations, 4) to obtain adequate lung re-expansion, and 5) optimal chest tube placement for drainage.
Several reports have demonstrated that VATS debridement is a valid treatment option for stage II empyema, which allows an appropriate control of infection and a complete restoration of pulmonary function in early stage empyemas. Formal exclusion criteria for a primary VATS approach are suspicion of lung abscess, bronchopleural fistula, tumor at initial work-up or the need of muscle flaps with or without thoracoplasty. Presumed stage III empyema with pleural thickening and signs of restriction on CT-scan no longer are formal contraindications, but the conversion rate to decortications via thoracotomy is higher.