Thoracoscopic lobectomy after bilateral lung transplantation

A 61-year-old female patient with a coin lesion in the right upper lobe was referred for surgery. Six years previously she had undergone bilateral lung transplantation through bilateral anterior thoracotomies. Computed tomography and positron emission tomography of the thorax revealed a 19-mm hypermetabolic lesion in the right upper lobe, but no other locoregional or distant disorder. The patient underwent wedge resection by video-assisted thoracic surgery (VATS). Frozen section revealed a large-cell carcinoma. Subsequently, a VATS right upper lobectomy with mediastinal lymph node dissection was performed. Final pathology demonstrated a pT1bN0M0 non-small-cell lung cancer of the right upper lobe. One year after the operation, the patient was alive and disease free. This case report and video illustrate the feasibility of a VATS anatomical resection after lung transplantation.