Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug 10;4(1):91.
doi: 10.1186/s40792-018-0496-2.

A new approach to left sleeve pneumonectomy: complete VATS left pneumonectomy followed by right thoracotomy for carinal resection and reconstruction

Toshio Fujino  1 , Masayuki Tanahashi  2 , Haruhiro Yukiue  2 , Eriko Suzuki  2 , Naoko Yoshii  2 , Masayuki Shitara  2 , Yasunori Kaminuma  2 , Hiroshi Niwa  2
Affiliations

A new approach to left sleeve pneumonectomy: complete VATS left pneumonectomy followed by right thoracotomy for carinal resection and reconstruction

Toshio Fujino et al. Surg Case Rep. .

Abstract

Background: Left sleeve pneumonectomy is a challenging operation that requires individualized approaches. Here, we present a new minimally invasive combined thoracoscopic approach.

Case presentation: A 61-year-old woman was diagnosed with tracheobronchial adenoid cystic carcinoma. The tumor originated from the left main stem bronchus, and tumor with carinal involvement was observed. We judged that complete resection would be possible via left sleeve pneumonectomy. However, because tumor involvement with the esophagus and descending aorta was suspected, evaluation of resectability in advance was necessary. After confirmation via examination thoracoscopy of no involvement with the surrounding organs, complete VATS left pneumonectomy was performed and followed by right thoracotomy for carinal resection and reconstruction.

Conclusions: When thoracoscopic surgery becomes mainstream, this minimally invasive combined thoracoscopic approach might be an optimal option for patients who require left sleeve pneumonectomy.

Keywords: Left sleeve pneumonectomy; New approach; Tracheobronchial tumor.

PubMed Disclaimer

Conflict of interest statement

Not applicable.

Informed consent was obtained from the patient for the publication of this case report.

The authors declare that they have no competing interests.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Computed tomography findings. a Coronal and b Sagittal view. A solid left main bronchial tumor with carinal involvement is observed
Fig. 2
Fig. 2
Endoscopic findings. a Before rigid bronchoscopic treatment. The tumor almost completely occludes the left main stem bronchus. b, c, and d Bronchoscopy 2 weeks after rigid bronchoscopic treatment. Almost the entire left main stem bronchus, two tracheal cartilage rings above the carina, and one right main stem bronchial ring distal from the carina are invaded by the tumor
Fig. 3
Fig. 3
Schematic figures. a Tumor location. b c-VATS establishment: ①Access window, 4th intercostal space, 50 mm; ②Assist window, 6th intercostal space, 40 mm; ③Camera port, 7th intercostal space, 12 mm. c Posterolateral thoracotomy, the carinal resection and reconstruction were completed under surgical field intubation
Fig. 4
Fig. 4
Macroscopic findings of the resected tracheobronchial tumor. a A front view of the ①tracheal stump, ②left main bronchial stump, ③right main bronchial stump. b The tumor and carina are observed from the tracheal lumen
See this image and copyright information in PMC

References

    1. Banki F, Wood DE. Techniques of performing left carinal pneumonectomy. Oper Tech Thorac Cardiovasc Surg. 2007;12:194–209. doi: 10.1053/j.optechstcvs.2007.07.001. - DOI
    1. Macchiarini P, Altmayer M, Go T, et al. Technical innovations of carinal resection for nonsmall-cell lung cancer. Ann Thorac Surg. 2006;82:1989–1997. doi: 10.1016/j.athoracsur.2006.07.016. - DOI - PubMed
    1. Yen YT, Lai WW. Right thoracotomy for carinal resection with left thoracoscopic pneumonectomy as a new approach for left sleeve pneumonectomy: a case report. Kaohsiung J Med Sci. 2010;26:609–614. doi: 10.1016/S1607-551X(10)70093-0. - DOI - PMC - PubMed
    1. Kondo T, Sagawa M, Sato M, et al. Left sleeve pneumonectomy performed through a clamshell incision with extracorporeal membrane oxygenation for bronchogenic carcinoma: report of two cases. Surg Today. 1999;29:807–810. doi: 10.1007/BF02482334. - DOI - PubMed

LinkOut - more resources