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Case Reports
. 2015 May 21:10:76.
doi: 10.1186/s13019-015-0276-z.

Single-stage bilateral thoracic surgery via a combined VATS and open approach for left central bronchogenic carcinoma with carinal invasion: report of two cases

Bo Ai  1 , Yongde Liao  2 , Zheng Zhang  3 , Xiangning Fu  4
Affiliations
Case Reports

Single-stage bilateral thoracic surgery via a combined VATS and open approach for left central bronchogenic carcinoma with carinal invasion: report of two cases

Bo Ai et al. J Cardiothorac Surg. .

Abstract

Background: Surgery for patients with left central bronchogenic carcinoma invading the carina is challenging due to the complexity of left sleeve pneumonectomy, carinal resection, and airway reconstruction and management. Here we describe a modified approach to overcome this problem.

Case presentation: Between March 2011 and September 2012, two patients with left central bronchogenic carcinoma invading the carina underwent single-stage bilateral thoracic surgery via a combined approach incorporating video-assisted thoracic surgery (VATS) and thoracotomy in our hospital. We reviewed our experience with this type of surgery and analyze its outcomes.

Conclusions: Single-stage, bilateral thoracic surgery incorporating video assisted thoracic surgery (VATS) and thoracotomy provides optimal exposure of the operative field, reduces surgical trauma, and ensures the integrity of tumor excision and exactness of tracheobronchial anastomosis. This may be a safe and feasible alternative for left carinal pneumonectomy.

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Figures

Fig. 1
Fig. 1
a The tumor in the left main bronchus extended up to the bifurcation of the upper and lower lobe orifices. Atelectasis of the left lung was seen. b Tumor involved the carina and proximal part of the right main bronchus. c CT showed an unobstructed airway at 19 months after the operation. d Bronchoscopy reveald an intact anastomosis, smooth mucosa
Fig. 2
Fig. 2
a The lower portion of the trachea, the carina, the left main bronchus, and the right main bronchus were exposed via a right thoracotomy. b The trachea and right main bronchus were anastomosed in an end-to-end fashion. c Ventilation through right bronchial intubation across the operative field. d pedicled azygos vein flap which were to completely encircle the anastomotic stoma
Fig. 3
Fig. 3
a Four thoracic ports were used for left thoracoscopy. b VATS left sleeve pneumonectomy: the left pulmonary artery was ligated and divided with an endoscopic stapler
See this image and copyright information in PMC

References

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