Document Detail

Anterior minithoracotomy: a direct approach to the difficult hilum for upper lobectomy, pneumonectomy, and sleeve lobectomy.
MedLine Citation:
PMID:  19908099     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Central lung cancers with pulmonary hilar involvement can pose a technical challenge when a lateral thoracotomy is used. Proximal vascular control and pulmonary vascular dissection from this approach can be challenging and potentially dangerous. We describe the use of a Chamberlain anterior minithoracotomy as an alternative approach for safe and reliable access to the pulmonary hilum.
METHODS: One hundred two consecutive patients undergoing the Chamberlain approach were identified through retrospective chart review from 2002 to 2009. The supine position was used, thus reducing the likelihood of down-lung syndrome. An 8-cm anterior thoracotomy was performed over the second interspace along the line of the pectoral fibers, with preservation of the mammary artery medially and the thoracoacromial neurovascular bundle laterally. Primary outcome variables included hospital course, complications, and mortality rate.
RESULTS: The mean age was 64.8 years (range, 20-89 years). Sex ratio (female:male) was 44:58. Neoadjuvant therapy was used in 43 patients (42.2%). Proposed resections were successful in 101 (99%) of 102 patients. Conversion to hemiclamshell was required in 1 patient for vascular control. Three perioperative deaths (2.9%; two pneumonectomies, one lobectomy) occurred.
CONCLUSIONS: The Chamberlain mini anterior thoracotomy provides direct access to the pulmonary hilum, facilitating dissection and vascular control for large and central tumors. Reduced perioperative pain and down-lung syndrome compared to lateral approaches can be achieved. Muscle function is preserved, and intrapericardial/hilar access is expeditious. This approach enhances hilar access and avoids the vascular control and hilar exposure challenges inherent with lateral thoracotomy.
Brian L Pettiford; Matthew J Schuchert; Ghulam Abbas; Arjun Pennathur; Sebastien Gilbert; Arman Kilic; James R Landreneau; Robert Jack; Joshua P Landreneau; David O Wilson; James D Luketich; Rodney J Landreneau
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Publication Detail:
Type:  Journal Article     Date:  2009-11-12
Journal Detail:
Title:  Annals of surgical oncology     Volume:  17     ISSN:  1534-4681     ISO Abbreviation:  Ann. Surg. Oncol.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-21     Completed Date:  2010-04-06     Revised Date:  2012-01-11    
Medline Journal Info:
Nlm Unique ID:  9420840     Medline TA:  Ann Surg Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  123-8     Citation Subset:  IM    
Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, Pennsylvania, USA.
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MeSH Terms
Aged, 80 and over
Lung Neoplasms / surgery*
Middle Aged
Pulmonary Artery / surgery*
Retrospective Studies
Surgical Stapling*
Survival Rate
Thoracic Surgery, Video-Assisted
Thoracotomy / methods*
Treatment Outcome
Young Adult
Comment In:
Ann Surg Oncol. 2011 Dec;18 Suppl 3:S315   [PMID:  21104032 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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