Eastern Cardiothoracic Surgical Society

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Lost? Right Lower Lobectomy via Uniportal Left Video Assisted Thoracoscopic Surgery
Joshua S. Newman, Stevan S. Pupovac, Miguel Alexis, David Zeltsman.
Northwell Health, New Hyde Park, NY, USA.

Objective:
Surgical management of lung lesions in patients with Karetenger Syndrome is rarely reported. The goal of our approach is to offer patients the most minimally invasive Uniportal Video Assisted Thoracoscopic Surgery (VATS) for curative anatomic lung resection.
Methods:
We used endobronchial blocker to establish single right lung ventilation. A single 2cm incision was performed in the 7th intercoastal space between mid and posterior axillary lines in the left chest. Left thoracic cavity was entered without incident. Extensive pneumonolysis was necessary to mobilize the right lung. Anatomic right lower lobectomy with en-block partial diaphragmatic resection was carried out and the specimen was removed from the chest within the specimen bag. The middle and upper lobes re-expanded well and a single 20 French chest tube was inserted through the existing VATS incision. The patient was extubated in the operating room and transferred to the recovery room in stable condition.
Results:
Patient did well and was discharged home on POD 2. Final pathology demonstrated no evidence of malignancy. Reactive lymph nodes, lung abscess with bronchiectasis, bronchiolitis and organizing pneumonia were described . Postoperatively, the patient was documented to have symptomatic relief of her chronic cough; no need for further surgical follow up deemed necessary.
Conclusions:
Situs inversus totalis in patients with Karetenger Syndrome presents major challenges with surgical management of most internal pathology, even more so of pulmonary parenchymal disorders. Despite significant difficulties with intraoperative anatomic conceptualization anatomic pulmonary resections can be safely performed with the most minimally invasive Uniportal VATS approach.


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