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. 2016 Jan;8(1):198-203.
doi: 10.3978/j.issn.2072-1439.2016.01.45.

Video-assisted thoracoscopic surgery tracheal resection and carinal reconstruction for tracheal adenoid cystic carcinoma

Jianxing He  1 , Wei Wang  1 , Jingpei Li  1 , Weiqiang Yin  1 , Xin Xu  1 , Guilin Peng  1 , Youping Chen  1 , Ping He  1
Affiliations

Video-assisted thoracoscopic surgery tracheal resection and carinal reconstruction for tracheal adenoid cystic carcinoma

Jianxing He et al. J Thorac Dis. 2016 Jan.

Abstract

We report a case of video-assisted thoracoscopic surgery (VATS) tracheal resection and carinal reconstruction in a patient with tracheal tumor. The patient presented with adenoid cystic carcinoma (ACC) of the distal trachea, extending along the right main bronchus with carinal invasion. The reconstruction procedure was assisted with cross-field ventilation. Postoperative clinical course of this case was good. The forced expiratory volume in the first second (FEV1) improved from 0.461 L (17% pred.) to 2.31 L (87% pred.) 1 month after the operation. VATS tracheal resection and carinal reconstruction is a feasible option for patients with tracheal tumor with carina involvement.

Keywords: Video assisted thoracic surgery (VATS); adenoid cystic carcinoma (ACC); carinal reconstruction; tracheal resection; tracheal tumor.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Chest CT revealed a lower tracheal mass involved with carina and right bronchus. CT, computerized tomography.
Figure 2
Figure 2
Reconstructed chest CT revealed a lower tracheal mass involved with carina and right bronchus. CT, computerized tomography.
Figure 3
Figure 3
VATS tracheal resection and carinal reconstruction for tracheal ACC (3). VATS, video-assisted thoracoscopic surgery; ACC, adenoid cystic carcinoma. Available online: http://www.asvide.com/articles/804
Figure 4
Figure 4
Ports design of VATS carinal resection and reconstruction. VATS, video-assisted thoracoscopic surgery.
Figure 5
Figure 5
Sketch of the lesion and operation plan.
Figure 6
Figure 6
Surgical techniques. (A) Transecting the azygos vein with 35 mm Endo cutter; (B) cutting off the distal trachea; (C) placing a cross-field endobronchial tube into the left main bronchus; (D) transecting the trachea, and bilateral bronchi; (E) creating a proper angle of newly reconstructed carina by performing a figure-of-eight suture between the remnants of the bilateral bronchi; (F) starting suture started on the cartilaginous section of the left main bronchus; (G) performing end-to-end anastomosis between remnant trachea and the left bronchus with running suture; (H) continuing to suture the first anastomosis during ventilation of the reinserted oral endobronchial tube; (I) performing the end-to-side anastomosis between the trachea and right main bronchus; (J) finishing the second anastomosis.
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References

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