Technical aspects of video-assisted thoracic surgery (VATS) pneumonectomy for tuberculosis: a review of attitudes to be taken

Closely related to the development of thoracic surgery, tuberculosis, once fully controlled through medical therapy, now emerges again as a threat, considering its multi drug-resistant and extensively drug-resistant forms. Pneumonectomy presents as a therapeutic option for treating complications of the disease, improving quality of life. Diseased lung harbors bacteria as a constant source of infection and antibiotic resistance development. The damaged lung also has no ventilatory function, working as a shunt, disturbing the patient's quality of life. Usually performed through conventional open thoracotomy, as video-assisted thoracic surgery (VATS) is now a well-established technique, its applicability in tuberculosis surgery must be addressed. Severe pleural adhesion, lymph node enlargement, hypertrophy of the bronchial circulation and difficult to compress lung parenchyma are the main technical difficulties found through this approach. Pneumonectomy is mostly described for the treatment of lung cancer in the literature. Here we review the indications and the main technical considerations to be taken during the thoracoscopic approach for this surgery, regarding the challenges presented by a benign inflammatory disease. Improving the health status of the patient, thorough previous nutritional and antibiotic therapy, taking care with adhesions, lymph nodes calcification, carefully identifying the structures and preventing bronchopleural fistula are the main points to be considered. Post-surgical chemotherapy is also of great importance. Pneumonectomy is a viable procedure through VATS. Conventional open thoracotomy, however, should not be neglected, associating both techniques as needed, always aiming for the best patient care.