Video-assisted thoracoscopic lobectomy for right middle lobe bronchiectasis.

The bronchiectasis process is irreversible, and only resection of the involved bronchiectatic segments offers the possibility of potential cure. We present our experience in video-assisted thoracoscopic lobectomy for localized right middle lobe bronchiectasis in 16 patients. From July 1994 to June 2002, we enrolled 16 patients with right middle lobe bronchiectasis. There were nine women and seven men, with a mean age of 39.7 years (range, 21-67 years). The mean duration of symptoms such as hemoptysis and chronic purulent productive cough was 7.3 years (range, 2-19 years). Surgical indications included repeat pulmonary infection with often abundant purulent, sometimes fetid, expectoration in eight patients (50%), frequent massive hemoptysis in four patients (25%), and both repeat pulmonary infection and hemoptysis in four patients (25%). During operation, all patients were placed in left lateral position under double-lumen intubated anesthesia. Three incisions were needed. One 1-cm incision for the camera port was created at the seventh intercostal space along the anterior axillary line and the other 1- and 4-cm incisions were created at the seventh and fifth intercostal spaces along the midclavicular line. Right middle lobectomy could be completed by use of either traditional or endoscopic instruments. The mean total operative time was 87 minutes (range, 60-110 minutes). The mean hospital stay was 6 days (range, 4-11 days). One patient suffered from a mild hemothorax complication that needed 10 days of pleural drainage. There was no surgical mortality in this study. The mean follow-up period was 45 months (range, 10-94 months). Overall, 14 (87.5%) patients were asymptomatic, and the other 2 (12.5%) obtained apparent symptomatic improvement after operation. Video-assisted thoracoscopic lobectomy for right middle lobe bronchiectasis is technically feasible using our approach and is potential safe in treating patients with localized right middle lobe bronchiectasis.