Three-dimensional CT Angiography Facilitates Uniportal Thoracoscopic Anatomic Lung Resection for Pulmonary Sequestration

Abstract BackgroundPulmonary sequestration (PS) is a rare lesion with independent blood supply from an anomalous systemic artery. A timely resection is considered the best treatment for PS, but the optimal approach is controversial. Three-dimensional computed tomography angiography (3D-CTA) has been widely utilized for precise thoracic surgery. This study aimed to investigate the safety of uniportal video-assisted thoracoscopic surgery (VATS) for PS assisted with preoperative 3D-CTA. MethodsThe data of patents with PS who underwent VATS anatomic lung resection between April 2011 and May 2021 in a single centre were retrospectively reviewed. They were divided into uniportal and tow-port groups according to the initial surgical plan. The perioperative parameters including the incidence of conversion to open thoracotomy, operation time, blood loss, complications and chest tube duration were analyzed. ResultsTwenty consecutive patients (9 in uniportal group and 11 in two-port group) underwent VATS for PS, including 12 female and 8 male patients, with a mean age of 45 years old (range, 24-60 years). Nine cases demonstrated recurrent febrile, cough, or hemoptysis; whereas the other 11 patients were asymptomatic. The 3D-CTA was utilized for all patients in the uniportal group and 1 patient in the two-port group. Eighteen (90.0%) intralobar and 2 extralobar PS were confirmed; and 18 (90.0%) lesions were located in the left thorax. The feeding vessels originated from the thoracic aorta in 16 patients (80.0%), the abdominal aorta in 3 (15.0%) and the inferior phrenic artery in 1 patient (5.0%). Thirteen lobectomies, 5 segmentectomies and 2 mass excisions were performed. There was no major bleeding or 30-day mortality. No conversion was needed in the uniportal group; whereas 6 (54.5%) conversions (4 to multiple-port and 2 to thoracotomy) occurred in the two-port group, indicating a significant difference (P=0.008). In addition, the operation time in the uniportal VATS group was significantly shorter than those in the two-port VATS group ([110.6 ± 25.5] min vs. [148.6 ± 42.1] min, P = 0.029). The other perioperative variables were similar between the two groups. During the follow-up of 5-75 months, no recurrence of hemoptysis was recorded. ConclusionPreoperative 3D-CTA facilitates the safe performance of uniportal VATS anatomic lung resection for PS, which might be associated with shorter operation time and lower conversion to thoracotomy.