European Journal of Cardio-Thoracic Surgery Advance Access published June 20, 2015
IMAGES IN CARDIO-THORACIC SURGERY
Cite this article as: Kouritas VK, George RS, Brunelli A, Kefaloyannis E. Lung herniation after uniportal video-assisted thoracic surgery lobectomy presenting with subcutaneous surgical emphysema. Eur J Cardiothorac Surg 2015; doi:10.1093/ejcts/ezv219.
Lung herniation after uniportal video-assisted thoracic surgery lobectomy presenting with subcutaneous surgical emphysema Vasileios K. Kouritas*, Robert S. George, Alessandro Brunelli and Emmanouel Kefaloyannis Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK * Corresponding author. Department of Thoracic Surgery, St James’s University Hospital, Beckett Street, Leeds LS9 8TF, UK. Tel: +44-113-2467559; fax: +44-113-2468875; e-mail: [email protected] (V.K. Kouritas). Received 28 March 2015; received in revised form 8 May 2015; accepted 18 May 2015
Keywords: Lung herniation • VATS lobectomy • Complication
Subcutaneous emphysema is a rare presentation of lung herniation after VATS lobectomy. Lung herniation occurs at the anterior utility incision, where the space is wider and not approximated with peri-
costal sutures (Fig. 1). Thoracic surgeons should be aware of this complication and its rare appearance. Conflict of interest: none declared.
Figure 1: The patient underwent a uniportal VATS right upper lobectomy for lung cancer. The chest drain was removed on the second postoperative day, after the air leak stopped. He was re-admitted 3 days later for subcutaneous emphysema. In the absence of an obvious cause for this, a CT scan was performed which showed that almost the entire middle lobe was herniated without evidence of vessel compression or lobe infarction. The patient was reoperated on without necrosis of the herniated part of the lung and because of this, it was re-positioned within the chest. No apparent air leak site could be identified. The utility port was closed using two pericostal approximation sutures over a new 28-Fr drain, which was removed on the second postoperative day.
© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
IMAGES IN CARDIOTHORACIC SURGERY
European Journal of Cardio-Thoracic Surgery (2015) 1–1 doi:10.1093/ejcts/ezv219
IMAGES IN CARDIO-THORACIC SURGERY
Cite this article as: Kouritas VK, George RS, Brunelli A, Kefaloyannis E. Lung herniation after uniportal video-assisted thoracic surgery lobectomy presenting with subcutaneous surgical emphysema. Eur J Cardiothorac Surg 2015; doi:10.1093/ejcts/ezv219.
Lung herniation after uniportal video-assisted thoracic surgery lobectomy presenting with subcutaneous surgical emphysema Vasileios K. Kouritas*, Robert S. George, Alessandro Brunelli and Emmanouel Kefaloyannis Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK * Corresponding author. Department of Thoracic Surgery, St James’s University Hospital, Beckett Street, Leeds LS9 8TF, UK. Tel: +44-113-2467559; fax: +44-113-2468875; e-mail: [email protected] (V.K. Kouritas). Received 28 March 2015; received in revised form 8 May 2015; accepted 18 May 2015
Keywords: Lung herniation • VATS lobectomy • Complication
Subcutaneous emphysema is a rare presentation of lung herniation after VATS lobectomy. Lung herniation occurs at the anterior utility incision, where the space is wider and not approximated with peri-
costal sutures (Fig. 1). Thoracic surgeons should be aware of this complication and its rare appearance. Conflict of interest: none declared.
Figure 1: The patient underwent a uniportal VATS right upper lobectomy for lung cancer. The chest drain was removed on the second postoperative day, after the air leak stopped. He was re-admitted 3 days later for subcutaneous emphysema. In the absence of an obvious cause for this, a CT scan was performed which showed that almost the entire middle lobe was herniated without evidence of vessel compression or lobe infarction. The patient was reoperated on without necrosis of the herniated part of the lung and because of this, it was re-positioned within the chest. No apparent air leak site could be identified. The utility port was closed using two pericostal approximation sutures over a new 28-Fr drain, which was removed on the second postoperative day.
© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
IMAGES IN CARDIOTHORACIC SURGERY
European Journal of Cardio-Thoracic Surgery (2015) 1–1 doi:10.1093/ejcts/ezv219
