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OBJECTIVES We summarize our experiences of video-assisted thoracoscopic surgery (VATS) sleeve lobectomy with bronchoplasty for non-small-cell lung cancer and discuss the indications and technical details of the operation. METHODS From September 2011 to December 2012, 15 patients underwent VATS sleeve lobectomy with bronchoplasty at our institution (right upper lobe 10, right middle and lower lobes 1, left lower lobe 2 and left upper lobe 2), with mediastinal lymphadenectomy. Three incisions were utilized. The utility incision was made at the fourth intercostal space, anterior axillary line. Simple continuous and simple interrupted suturing of the membranous and cartilaginous portions of the bronchus were performed for the anastomosis. RESULTS All procedures were uneventful, with a median operative time of 165 min, a median bronchial anastomosis time of 44 min and a median blood loss of 150 ml. There were no conversions to thoracotomy. There were 14 squamous carcinomas and 1 adenocarcinoma. All patients recovered well, and 1 experienced a minor complication. The median duration of chest tube drainage was 5.4 days, and the median length of hospital stay was 7 days. All patients were followed postoperatively for a range of 1–16 months without tumour recurrence. CONCLUSIONS VATS sleeve lobectomy with bronchoplasty is safe and effective. The utility incision placed at the fourth intercostal space, anterior axillary line, is convenient for the anastomosis, and the suturing technique is expeditious and secure. Preserving the azygos vein does not compromise exposure for the anastomosis. This technique is very suitable for centrally located lung cancers <3 cm in diameter, particularly when the cancers are located within the brachial lumen. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: To determine the late incidence of pulmonary arteriovenous malformations after bidirectional Glenn in patients with azygos continuation of the inferior vena cava (Kawashima operation). Methods: From 1990 to 2006, 21 patients underwent a Kawashima procedure at a median age of 2.3 years (0.5–8 years). Underlying anatomy included atrioventricular septal defect [14], double-outlet right ventricle [13], pulmonary atresia , pulmonary stenosis , total anomalous pulmonary venous drainage and bilateral superior vena cavae [14]. Results: There was one hospital death after Kawashima due to low output syndrome. Follow-up was complete in all but one patient. Two patients died 23 days and 4 years after Kawashima following cardiac reinterventions (one atrioventricular valve replacement and one Fontan completion). Thirteen patients developed pulmonary arteriovenous malformations after a median of 4 years (2–9 years) after Kawashima. Freedom from development of arteriovenous malformations was 47% at 5 years (95% CI: 23–69%). A total of 16 patients underwent Fontan completion, 12 for cyanosis related to pulmonary arteriovenous malformations and four for decreased exercise capacity. Only three patients were left without Fontan completion at 4, 9 and 13 years after Kawashima. The two patients who had more than 9 years of follow-up after Kawashima had antegrade flow preserved between the ventricle and the pulmonary arteries. Conclusion: Unless some hepatic blood flow is directed to both lungs, most, if not all patients with a Kawashima procedure will ultimately develop pulmonary arteriovenous malformations. Elective non-fenestrated Fontan completion in the years following Kawashima procedure should be recommended. [Copyright &y& Elsevier]

Abstract: Objective: Preliminary report: presentation of the new technique of transcervical right upper lobectomy with transcervical extended mediastinal lymphadenectomy (TEMLA) for NSCLC. Methods: Two patients underwent the operation that was performed through the collar incision, with elevation of the sternal manubrium with the mechanical sternal retractor. TEMLA and bilateral mediastinal lymph node excision (stations 1, 2R, 4R, 2L, 4L, 3A, 3P, 7 and 8) and bilateral supraclavicular lymph node excision were performed (frozen section analysis: all nodes negative). The mediastinal pleura was opened and the following structures were dissected in the open fashion with standard surgical instruments and divided with the use of endostaplers: the azygos vein, the upper trunk of the right pulmonary artery, the branch of the superior pulmonary vein to the upper lobe, the upper lobe bronchus, the segment 2 artery, the posterior part of the oblique fissure and the horizontal fissure. The operation was performed with the use of one videothoracoscopic (VTS) port for insertion of 5mm, 30 degree VTS camera for intraoperative control and for single thoracic drain for the postoperative period. Results: The operative times were 250 and 270min, respectively; intraoperative blood loss was 110 and 100ml, respectively. There were no intraoperative complications. The postoperative course was remarkably smooth. The final pathologic report: large cell carcinoma pT2N0M0 and squamous cell carcinoma pT2N0M0, no metastatic changes of 51 and 41 mediastinal and intrapulmonary (stations 10, 11 and 12) and supraclavicular nodes, respectively. Conclusions: This preliminary report indicates possible advantages of the transcervical right upper lobe pulmonary resection including: (1) extremely radical, minimal invasive procedure with no need for utility thoracotomy; (2) dissection performed with standard surgical instruments in the open fashion. [Copyright &y& Elsevier]

Thoracic duct ligation is a widely accepted treatment option for chylothorax. This case report describes another treatment approach for recurrent chylothoraxes after thoracic duct ligation. A 40-year-old woman had chylothoraxes after thoracic duct ligation. She underwent a secondary surgery to ligate the thoracic duct. Three days later, the number of chylothoraxes increased compared with presurgery, and we anastomosed the thoracic duct and azygos vein after releasing the thoracic duct ligation. The patient recovered smoothly and was followed up for 2 years. This case shows that anastomosis of the thoracic duct and azygos vein is an alternative surgical approach to treat recurrent chylothoraxes. [ABSTRACT FROM AUTHOR]

Abstract: Giant venous hemangiomas of the azygos arch are exceedingly rare and idiopathic. To the best of our knowledge, there have been only two reports of azygos hemangioma. We report a case of hemangioma of azygos arch in a 46-year-old man after a complete resection and discuss the strategy that was used for the diagnosis and therapy. [Copyright &y& Elsevier]