Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
Department of Anaesthetics, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
Multimed Man Cardiothorac Surg. 2024 Mar 25;2024. doi: 10.1510/mmcts.2023.063.
We describe a rare procedure involving near-total robotic-assisted thoracoscopic surgery resection of a right posterior Pancoast tumour. Four ports and an assistant port were used. The DaVinci X system was used. The lobectomy was performed first to allow for adequate exposure to the apex and spine. The lateral aspect of ribs 1 to 4 was resected next, and the extrathoracic space was entered. Dissection proceeded through this space superiorly up to the level of the scapula and then posteriorly towards the spine. The second to the fifth ribs were dissected off the chest wall and resected medially off the spine at the rib heads. Further postero-superior exploration revealed the tumour to be invading the transverse process of the second rib, with ill-defined margins. Because of this development, and with the support of the spinal surgeons, a small high posterior thoracotomy was performed to complete the procedure and remove the specimen en bloc. The postoperative recovery was uneventful, and the patient was discharged on post-operative day 5. The final histological report confirmed a squamous non-small-cell lung cancer (pT3N0M0) with negative margins (R0). Asymptomatic recurrence was noted near the margin of the second rib resection posteriorly 1 year postoperatively and was successfully treated with radiotherapy.
我们描述了一种罕见的手术过程，涉及全机器人辅助胸腔镜下右后 Pancoast 肿瘤的近乎完全切除术。使用了四个端口和一个辅助端口。使用了达芬奇 X 系统。首先进行肺叶切除术，以充分暴露顶部和脊柱。接下来切除第 1 至 4 肋骨的外侧部分，并进入胸腔外空间。在这个空间内向上解剖到肩胛骨水平，然后向后向脊柱方向进行。然后从肋骨头部将第 2 至第 5 肋骨从胸壁上解剖下来并切除。进一步的后上方探查显示肿瘤侵犯了第二肋骨的横突，边界不清晰。由于这一发展，在脊柱外科医生的支持下，我们进行了一个小的高位后胸腔切开术来完成手术并整块切除标本。术后恢复顺利，患者于术后第 5 天出院。最终的组织学报告证实为鳞状非小细胞肺癌（pT3N0M0），边缘阴性（R0）。术后 1 年，在后第二肋骨切除边缘处发现无症状复发，成功接受放疗治疗。
