Journal Article

V-049TRACHEAL SLEEVE LOBECTOMY FOR MUCOEPIDERMOID CARCINOMA OF THE CARINA

Giuseppe Marulli and F. Rea

in Interactive CardioVascular and Thoracic Surgery

Published on behalf of European Association for Cardio-Thoracic Surgery

Volume 18, issue suppl_1, pages S13-S13
Published in print June 2014 | ISSN: 1569-9293
Published online June 2014 | e-ISSN: 1569-9285 | DOI: http://dx.doi.org/10.1093/icvts/ivu167.49
V-049TRACHEAL SLEEVE LOBECTOMY FOR MUCOEPIDERMOID CARCINOMA OF THE CARINA

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  • Cardiovascular Medicine
  • Cardiothoracic Surgery

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Objectives: Tracheal sleeve lobectomy is a particularly challenging operation as it involves, in addition to sleeve lobectomy with carinal resection and end-to-end anastomosis of the left main bronchus to the trachea, a creation of the secondary end-to-side anastomosis of the right lower bi-lobe either to the trachea or the left main bronchus. Right upper tracheal sleeve lobectomy is usually required for management of neoplasms involving the trachea or the carina at the level of the right main bronchus. Preoperative evaluation includes radiological and endoscopic assessment in order to accurately plan the type of resection and airway reconstruction. In this video we show the technique of tracheal sleeve lobectomy in a mucoepidermoid carcinoma of the carina involving the right main bronchus on the medial part until the origin of the bronchus intermedius.

Video description: After performing a standard right upper lobectomy, the trachea is incised over the carina that is removed after the transection of the origin of the left main and intermedius bronchi. At that point the ventilation is carried out by intubation of the left main bronchus through the operative field. Release manoeuvres such as pericardial U-shaped opening and tracheal mobilization are performed before the anastomosis. Thus, first an end-to-end anastomosis between the trachea and left main bronchus is carried out by using high frequency jet ventilation, then an end-to-side anastomosis between the trachea and bronchus intermedius is performed after creation of a window on the trachea. The two anastomoses are covered with a pericardial flap and the anastomoses are checked with bronchoscopy.

Conclusions: Tracheal sleeve lobectomy is a challenging operation that requires a meticulous technique and anaesthesiological management. Low-grade tumours involving the carina are the best indication for this kind of operation.

Disclosure: No significant relationships.

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine ; Cardiothoracic Surgery

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