Thoracoscopic atypical resection of the left lung (metastasectomy) under conditions of submaximal reduction of the contralateral lung

The high frequency of various lesions of the lung parenchyma explains the widespread use of lung resection in surgical practice.Pulmonary surgery is distinguished by a number of important nuances: the anatomical features of the organs located in the chest, difficult access to them, the need to turn off the operated lung from breathing.

When it is necessary to operate on one lung, and the contralateral lung is compromised by various pathological processes, the risk of surgical intervention is extremely high. This is especially true if surgery is planned on a single lung. The article describes a clinical case of surgical treatment of a patient with a metastatic tumor of the left lung. Previously, he was operated on as a lower bilobectomy for dimorphic cancer of the lower lobe of the right lung pT3N1M1a stage IV. According to spirometry, a significant decrease in the respiratory capacity of the lungs was noted, due to previously performed operations with a reduction of 70% of the parenchyma of the right lung. Under these conditions, the question of the method of respiratory support required for surgery on the left lung was acute. The volume of the remaining upper lobe on the right was not enough to provide adequate oxygenation of the patient’s blood, while the operation on the breathing left lung promised intraoperative difficulties and possible complications. Moreover, the operation was planned in a thoracoscopic version, which would not have been possible under such conditions.
The method of choice in these circumstances was the use of extracorporeal membrane oxygenation (ECMO) technology.
The patient underwent atypical thoracoscopic resection of the upper lobe of the left lung. During the operation, there were
no respiratory and hemodynamic disorders, blood saturation was 100%. The postoperative period is smooth, the patient
was discharged in a satisfactory condition, without respiratory deficit.