Selective lobar collapse for video-assisted thoracic surgery.

Background: Video-assisted thoracic surgery (VATS) is conventionally performed under single-lung ventilation. A small proportion of patients are often excluded from undergoing VATS because of their inability to tolerate single-lung ventilation. We describe a simple technique of selective lobar lung collapse that may help to recruit additional, selected patients for VATS.

Methods: We use a standard suction catheter placed under bronchoscopic guidance to the target lobar bronchus through a single-lumen endotracheal tube. The catheter is left open to air, or suction can be applied to facilitate lobar collapse. The remaining lobe of the same lung can be ventilated throughout surgery. Surgery is performed using standard VATS techniques.

Results: Using this technique we have successfully performed VATS on 63 chest sides in 35 patients. The procedures performed included thoracodorsal sympathectomies (n = 28), mechanical pleurodesis procedures (n = 3), mediastinal and pleural biopsies (n = 2), and lung wedge resections (n = 2). We encountered no mortality or morbidity in all cases.

Conclusions: This technique is simple and safe and requires no expensive disposable devices. Although not essential for most patients undergoing VATS, it deserves to be in the armamentarium of the thoracic surgeon. Further studies will be required to better define its application in clinical practice.