Transposition of pulmonary veins for mobilization of residual right middle and lower lobes after carinal right upper lob
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CASE REPORT
Transposition of pulmonary veins for mobilization of residual right middle and lower lobes after carinal right upper lobectomy: a unique pulmonary hilar mobilization technique for safe tension‑free airway anastomosis Takeshi Shiraishi1 · Leona Yamamoto1 · Toshihiko Moroga1 · Naoko Imamura1 · So Miyahara1 · Ryuichi Waseda1 · Toshihiko Sato1 · Shin‑ichi Yamashita1 · Akinori Iwasaki1 Received: 30 May 2019 / Accepted: 13 August 2019 © The Japanese Association for Thoracic Surgery 2019
Abstract Unique right hilar mobilization was performed by pulmonary venous transposition of the right middle and lower lobe veins to the opening of the right upper pulmonary vein to achieve tension-free airway anastomosis after carinal right upper lobectomy for a patient with adenoid cystic carcinoma. The right middle and lower lobes were reconstructed safely thereafter by side-to-end anastomosis between the side of the lower trachea and intermediate bronchus with acceptable suturing tension. Keywords Carinal resection · Carinal right upper lobectomy · Hilar release · Venous transposition · Lung cancer
Introduction A variety of techniques for airway reconstruction after carinal or carinal right upper lobe resection have been proposed; however, these techniques remain challenging and high-risk procedures. The most important point for accomplishing this complex surgery is the achievement of safe, tension-free airway anastomosis. We herein report a case of carinal right upper lobectomy in which the right intermediate bronchus was successfully implanted at the side of the lower trachea after transposition of the middle and lower pulmonary veins to the opening of the right upper pulmonary vein.
Case A 70-year-old woman visited our hospital due to episodes of severe cough and hemosputum. Bronchoscopy and computed tomography revealed an intraluminal tumor that had * Takeshi Shiraishi tshiraishi‑[email protected] 1
Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, 7‑45‑1, Jonan‑ku, Fukuoka 814‑0180, Fukuoka, Japan
completely obstructed the right main bronchus and extended to the middle of the intermediate bronchus (Fig. 1a, b). A bronchoscopic biopsy of the tumor returned a diagnosis of adenoid cystic carcinoma (ACC). After performing tumor debulking by a rigid-bronchoscopic technique, the airway caliber for the right lung was re-established, and the tumor extension was confirmed to have reached as far as immediately before the opening of the middle lobe bronchus. Tumor extension to the left main bronchus was found as the minimum degree of extension. Based on these findings, complete resection of the lesion by carinal right upper lobectomy with most of the right intermediate bronchus was thought to be possible.
Operation The chest was entered via right posterolateral thoracotomy through the fifth intercostal space. After dividing the interlobar fissures between the right upper, middle and lower lobes, the distal trachea and carina, including the bilateral main bronchus, were
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