Kenji Nezu, MD, PhD, Naoki Mukai, MD, Yusuke Nishi, MD, Katsuhiro Tomofuji, MD, Takaaki Takebayashi, MD, Naoki Ishida, MD, Hajime Satoh, MD, PhD, Yoshinori Imai, MD, PhD, Jota Watanabe, MD, PhD, Kenzo Okada, MD, PhD, Toshihiko Sakao, MD, PhD, Shinsuke Kajiwara, MD, PhD. Uwajima City Hospital
A 74-year-old man, who had previously undergone low anterior resection for rectal cancer and segmental hepatectomy (S5 and S6) for liver metastases approximately 2 years previously, was observed to have a solitary lung nodule and a nodule located between the diaphragm and right lobe of the liver.
We planned a transdiaphragmatic approach using video-assisted thoracoscopic surgery for the resection of the lesions to evade the adhesion by hepatectomizing it of the last time.
The operation was performed by using a preoperative three-dimensional (3D)-computed tomography (CT) visualization system (SYNAPSE VINCENT). Specifically, the appropriate position of the port for thoracoscopic surgery was selected and the position of the nodule under the diaphragm was confirmed using the system.
During the operation, we first performed thoracoscopic partial resection of the lung and confirmed the portion of the diaphragm located directly above the nodule by using intraoperative thoracoscopic ultrasonography. Subsequently, we cut and opened the diaphragm and resected the subphrenic nodule using ultrasonic incision and a coagulation device.
The post-operative pathological diagnoses were lung metastasis and pleural dissemination derived from rectal cancer.
In conclusion, the approach through the diaphragm using thoracoscopy is useful and safe for tumor resection in the subphrenic area, and the operation performed by using a preoperative 3D-CT visualization system facilitates the identification of accurate port positions for the thoracoscope, and confirms the location of the tumor.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79118
Program Number: P149
Presentation Session: Poster (Non CME)
Presentation Type: Poster