Bronchial sleeve resections

Abstract

Although bronchial sleeve resections were previously defined as an alternative technique to pneumonectomy for patients with limited pulmonary reserve, currently these resections are applied as a standard even in patients having normal pulmonary capacity. Pneumonectomy, itself, is a disease, and sleeve lobectomies can be performed without compromising oncological principles and without causing significant morbidity and mortality. In parallel with the developments in surgical techniques, bronchial sleeve resections can be performed by videothoracoscopic and robotic surgeries. Major complications in sleeve lobectomies are bronchial dehiscence, bronchopleural fistulas, and broncho-arterial fistulas. Late complications are bronchial stenosis and tumor recurrence.

Keywords: Anastomosis; bronchial sleeve lobectomy; sleeve resection.

Figure 1. The illustration shows location of the lesions for various sleeve resection indications. (a) Right upper sleeve lobectomy. (b) Right sleeve bilobectomy inferior. (c) Right middle sleeve lobectomy. (d) Right lower sleeve lobectomy. (e) Left upper sleeve lobectomy. (f) Left lower sleeve lobectomy.

Figure 2. Flexible bronchoscopy imaging shows a tumor originating from the right upper lobe and extending into the right main bronchus. LMB: Left main bronchus; RMB: Right main bronchus; IMB: Intermediate bronchus; RULB: Right upper lobe bronchus.

Figure 3. The anastomosis begins at the proximal bronchus with the first suture that is passed from the outside to the inside and continues from the distal end from the outside to the inside.

Figure 4. The inner side is sutured as described, and the end of the suture is held out posteriorly by passing it from the inside to the outside. A second suture (green color) is passed from the outside to the inside, then the inside to the outside, and all sutures are tied with the first suture tip at the extraluminal region of bronchus.

Figure 5. The outer face anastomosis is completed as running technique with the second suture material (green color).

Figure 6. Sutures are knotted extraluminally at the anterior region and anastomosis is completed.

Figure 7. The bronchial anastomosis should be buttressed by a pedicled tissue (e.g., pericardial adipose tissue, thymus, intercostal muscle, diaphragm).