VATS with Chest Wall Resection

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Presentation transcript:

VATS with Chest Wall Resection Robert J. McKenna M.D. Chief, Thoracic Surgery Cedars Sinai Medical Center

Disclosures Speaker for Ethicon VATS Lobectomy Courses Advisory Board for Ethicon Speaker for Covidien VATS Lobectomy Courses

Intercostal Muscle Flap VATS Chest Wall Resection ▓ Intercostal Muscle Flap

Intercostal Muscle Flap VATS Chest Wall Resection Intercostal Muscle Flap ▓ First mobilize through utility incision Then with VATS to vertebral body

VATS for Pancoast Tumors VATS Chest Wall Resection ▓ VATS for Pancoast Tumors

Traditional Posterior Approach In my opinion, this approach probably IS ideal for slightly lower tumors that don’t actually invade the structures behind and above the first rib (the ones that are probably not really appropriately called Pancoasts. Here’s an example of one of those I did recently with one of our neurosurgeons . She had back and shoulder pain, but not arm pain or the other Pancoast-Tobias syndrome symptoms. She received neoadj chemorads, a negative mediastinoscopy, and then came to surgery Here, we resected ribs 2-4 including the transverse processes, and actually did a total vertebrectomy with reconstructions at T3.

Anterior Approach So here, we’re on the left side. We did resect the clavicle (which we generally did early on in our experience. You can see . . . This case required resection and reconstruction of the artery.

Pancoast: VATS Hybrid Resect ribs 1-4 VATS Lobectomy

Thanks Herbert Decaluwe

tHANKS

Complete First Rib Resection: VATS Chest Wall Resection TOS ▓ Complete First Rib Resection: Entire first rib Cut by sternum Disarticulate posteriorly

Venous Symptoms Subclavian Vein ▓ VATS First Rib Resection Costo-clavicular Ligament First Rib Subclavian Vein

VATS Chest Wall Resection TOS Incisions ▓

TOS Instruments 14 “ Dale First Rib Rongeur Cobb 11” Elevator ▓ VATS Chest Wall Resection TOS Instruments ▓ 14 “ Dale First Rib Rongeur Cobb 11” Elevator

VATS TOS Video Rib Cutter Rib

Complex Procedures are Possible with VATS VATS Chest Wall Resection Possibilities ▓ Complex Procedures are Possible with VATS