Right Lower Sleeve Lobectomy With Double-Barreled Bronchoplasty for a Centrally Located Lung Cancer Kazuhisa Tanaka, MD, Takahiro Nakajima, MD, PhD, Junichi Morimoto, MD, and Ichiro Yoshino, MD, PhD Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
FEATURE ARTICLES
Fig 1.
63-year-old man was evaluated for a 33 30 mm pulmonary nodule arising in the right lower lobe (Fig 1A, arrow). Endobronchial ultrasound-guided transbronchial needle aspiration revealed small cell carcinoma without evidence of nodal metastasis. We performed an operation followed by adjuvant chemotherapy. During the operation, the tumor was noted to infiltrate the membranous part of the intermediate bronchus. We performed a right lower lobectomy with dissection of the right mainstem bronchus (RMB), upper lobe bronchus (ULB), and middle lobe bronchus (MLB) (Fig 1B). To reconstruct the bronchus, we created a new bifurcation with the right ULB and MLB using four interrupted 4-0 polydioxanone sutures. Then, we anastomosed it to the
A
Address correspondence to Dr Nakajima, Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, chuo-ku, Chiba, 260-8670, Japan; e-mail: takahiro_nakajima@ med.miyazaki-u.ac.jp.
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
RMB using eight interrupted sutures (Fig 1C). Finally, the bronchus was reconstructed in a double-barreled fashion (Fig 1B). The surgical margin was negative and achieved R0 resection. Pathologically, station 7 was positive (pT2aN2M0). The respiratory function was well preserved (preoperative/predicted/postoperative forced vital capacity 4.13 L / 2.95 L / 2.84 L). The bronchial anastomosis was well healed and patent (Fig 1D). Double-barreled reconstruction of the lobar bronchus is useful for preserving pulmonary function [1]. The key part of this procedure is making an anastomosis in the natural position of each lobe without considering each membranous or cartilage part of the bronchus.
Reference 1. Cerfolio RJ, Deschamps C, Allen MS, Trastek VF, Pairolero PC. Mainstem bronchial sleeve resection with pulmonary preservation. Ann Thorac Surg 1996;61:1458–63. Ann Thorac Surg 2015;99:1829 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.12.050
FEATURE ARTICLES
Fig 1.
63-year-old man was evaluated for a 33 30 mm pulmonary nodule arising in the right lower lobe (Fig 1A, arrow). Endobronchial ultrasound-guided transbronchial needle aspiration revealed small cell carcinoma without evidence of nodal metastasis. We performed an operation followed by adjuvant chemotherapy. During the operation, the tumor was noted to infiltrate the membranous part of the intermediate bronchus. We performed a right lower lobectomy with dissection of the right mainstem bronchus (RMB), upper lobe bronchus (ULB), and middle lobe bronchus (MLB) (Fig 1B). To reconstruct the bronchus, we created a new bifurcation with the right ULB and MLB using four interrupted 4-0 polydioxanone sutures. Then, we anastomosed it to the
A
Address correspondence to Dr Nakajima, Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, chuo-ku, Chiba, 260-8670, Japan; e-mail: takahiro_nakajima@ med.miyazaki-u.ac.jp.
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
RMB using eight interrupted sutures (Fig 1C). Finally, the bronchus was reconstructed in a double-barreled fashion (Fig 1B). The surgical margin was negative and achieved R0 resection. Pathologically, station 7 was positive (pT2aN2M0). The respiratory function was well preserved (preoperative/predicted/postoperative forced vital capacity 4.13 L / 2.95 L / 2.84 L). The bronchial anastomosis was well healed and patent (Fig 1D). Double-barreled reconstruction of the lobar bronchus is useful for preserving pulmonary function [1]. The key part of this procedure is making an anastomosis in the natural position of each lobe without considering each membranous or cartilage part of the bronchus.
Reference 1. Cerfolio RJ, Deschamps C, Allen MS, Trastek VF, Pairolero PC. Mainstem bronchial sleeve resection with pulmonary preservation. Ann Thorac Surg 1996;61:1458–63. Ann Thorac Surg 2015;99:1829 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.12.050
