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@#Objective To explore the safety and feasibility of preferential manual bronchoplasty in single-port video-assisted thoracoscopic surgery (VATS) upper lobectomy. Methods The clinical data of 457 patients with non-small cell lung cancer who underwent single-port VATS lobectomy in the Department of Thoracic Surgery of Peking University First Hospital from March 2020 to March 2022 were retrospectively analyzed. The patients were divided into a preferential manual bronchoplasty group and a traditional single-port VATS lobectomy group with a 1 : 1 propensity score matching for further research. Results A total of 204 patients were matched, and there were 102 patients in each group. There were 50 males and 52 females aged 62.2±10.1 years in the preferential bronchoplasty group, and 49 males and 53 females aged 61.2±10.7 years in the traditional single-port VATS group. The preferential bronchoplasty group had shorter surgical time (154.4±37.0 min vs. 221.2±68.9 min, P<0.01), less bleeding (66.5±116.9 mL vs. 288.6±754.5 mL, P=0.02), more lymph node dissection (19.8±7.5 vs. 15.2±4.7, P<0.01), and a lower conversion rate to multi-port or open surgery (2.3% vs. 13.8%, P=0.04) in left upper lobe resection. In the right upper lobe resection surgery, there was no statistical difference in postoperative results between two groups. There was no perioperative death or occurrence of bronchopleural fistula in both groups. Conclusion Compared with traditional single-port VATS upper lobectomy, preferential bronchoplasty has similar safety and feasibility. In addition, priority bronchoplasty in left upper lobectomy has the advantages of shorter surgical time, less bleeding, more lymph node dissection, and lower conversion rate to multi-port or open surgery.
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@#Objective To explore the feasibility of robotic sleeve lobectomy and bronchoplasty and to summarize the experience of quality control and technical process management. Methods From January to December 2018, our hospital completed robotic sleeve lobectomy and bronchoplasty for 5 patients, including the upper right lung lobe in 2 patients, the middle right lung lobe in 1 patient and the lower left lung lobe in 2 patients. There were 3 males and 2 females with an age of 56.6 (39-75) years. The surgical approach was the same as the surgical incision of the robotic lobectomy. During the operation, the lobes were separated, all enlarged mediastinal lymph nodes were cleaned, pulmonary hilum was dissected, pulmonary arteriovenous vessels and bronchi were exposed, and pulmonary vessels were treated. After exposing the main bronchi, the bronchi were cut off at the distal end of the lesion, and the lobes where the lesion was located (including lesions) were excised by sleeve type and the bronchi were continuously sutured with 3-0 Prolene from the back wall for anastomosis. After the anastomosis, no air leakage was found in the expanded lung, and the anastomosis was no longer wrapped. Results The operation time was 147.4 (100-192) min, including bronchial anastomosis time 17.6 (14-25) min. Intraoperative blood loss was 60.0 (20-100) mL, and 20 (9-37) lymph nodes were dissected. Three patients had squamous cell carcinoma, 1 adenocarcinoma, and 1 neuroendocrine tumor. All patients showed negative results in the freezing pathology of bronchial stump during operation. All patients recovered well after surgery, without perioperative complications, and the anastomosis was smooth. Postoperative hospital stay was 10.8 (7-14) days. The patients were followed up for 6 to 12 months without anastomotic stenosis or other complications. Conclusion Since the robot system is a special instrument with 3D vision and 7 degrees of freedom for movable joints, the robotic bronchial suture is more flexible and accurate. The robotic sleeve lobectomy and bronchoplasty are safe and feasible.
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ObjectiveTo explore the surgical technique and effectiveness of uniportal video-assisted thoracoscopic double-sleeve lobectomy and its clinical popularization value. MethodsThe clinical data of 19 consecutive patients (18 left-sided operations and 1 right-sided operation), who underwent uniportal video-assisted thoracoscopic double-sleeve lobectomy in Shanghai Pulmonary Hospital of Tongji University between Dec. 2016 and Jul. 2018, were included. Pre-, intra- and post-operative indicators were statistically analyzed, and the surgical patients were followed up. ResultsAmong 19 patients, there were 17 males and 2 females, with an average age of (62.3±6.6) years. The average operative time was (258.0±66.6) min, average operative blood loss was (210.0±157.8) mL, average bronchus anastomosis time was (26.0±5.8) min, average artery anastomosis time was (47.7±7.2) min, and average postoperative hospital stay was (7.6±4.5) d. Postoperative pathologic examination indicated that 15 cases had squamous cell carcinoma, 2 had adenocarcinoma, 1 had small cell carcinoma, and 1 had large cell carcinoma. TNM staging: 11 cases was IIIa and 8 was IIIb. Four patients suffered postoperative complications, including 1 case of thrombosis at the vascular anastomosis, 1 arrhythmia and 2 prolonged airleak. There were no bronchial anastomotic fistula and anastomotic stenosis, vascular anastomosis stenosis or operative death. The average followup time was (16.4±6.4) months and no tumor recurrence or metastasis was found during follow-up after operation. ConclusionUniportal video-assisted thoracoscopic double-sleeve lobectomy is a technique-demanding operation, which can be carried out in the thoracic centers with endoscopy proficiency. It is feasible for completely removing tumor, preserving lung function to the greatest extent, and reducing surgical trauma to achieve rapid recovery of patients.
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Endobronchial inflammatory myofibroblastic tumor is a rare primary lung disease. A 39-year-old woman with dyspnea and a productive cough underwent complete surgical resection of a small-sized inflammatory myofibroblastic tumor that invaded the left main bronchus and the carina with lung-saving modified left one-stoma-type carinoplasty. We report this case with a review of literature.
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Adult , Female , Humans , Bronchi , Bronchial Neoplasms , Cough , Dyspnea , Lung Diseases , MyofibroblastsABSTRACT
Objective The aim of this study is to review the surgical experience of bronchoplasty and pulmo-nary arterioplasty in treatment of central-type lung cancer. Methods From 2003 to 2005,36 cases of patients with central-type lung cancer underwent bronchoplasty and pulmonary arterioplasty. There were 28 males and 8 females with a mean age of 62 years. Accordlng to pTNM classification. 5 cases were in stage ⅡI B,and 27 in stage Ⅲ A and 4 in stage Ⅲ B. Histologically,there were 24 cases of squamous cell carcinoma,6 cases of adenocarcinoma,1 case of small cell lung cancer and 5 cases of adenesquamous carcinoma. Results No patients died in the perioperative peri-od. The overall 1-,3-, and 5-year survival rate were 74% (26/35) ,48% (11/23) and 33% (3/9) ,respectively.Conclusion The results suggest that bronchoplasty and pulmonary arterioplasty can decrease the proportions of total pneumonectomy and exploratory thoracetomy and expand the indication of operation. Bronchoplasty and pulmonary ar-terioplasty can be achieved with satisfactory outcome for central-type lung cancer,especially for those patients with ad-vanced lesions or poor pulmonary function.
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Objective To investigate the effectiveness and the surgical experience of bronchoplasty and pulmonary artery reconstruction in the treatment of lung cancer of the left pulmonary artery affected. Methods From January, 1990 to December, 2004, 16 patients with lung cancer of the left pulmonary artery affected underwent bronchoplasty and pulmonary artery reconstruction. According to TNM classification, 16 patients were in stage ⅢA. The surgical procedures included sleeve resection of bronchus in 16 cases, sleeve resection of pulmonary artery in 11 and wedge resection of pulmonary artery in 5. Results The overall 1, 3 and 5-year survival rates were 75.0 %, 45.5 %, and 33.3 % respectively. Conclusion The results suggest that brenchoplasty and pulmonary artery reconstruction for the patients with lung cancer of pulmonary artery affected is an effective surgical technique. This method extends the surgery indications to patients with poor lung function and senility by reducing the ratio of pneumonectomy and improving postoperative quality of life. Therefore, it is clinically valuable.
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Carinal resection is technically demanding and the surgical risk is relatively high. When tumor is confined around the carina, then lung parenchymal sparing surgery is technically feasible in selected cases. We performed carinal resection and reconstruction without pulmonary resection for a patient suffering with squamous cell carcinoma that involved the carina and this patient had undergone right upper lobectomy 19 months previously due to lung cancer.
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Humans , Carcinoma, Squamous Cell , Lung , Lung Neoplasms , Stress, PsychologicalABSTRACT
Bronchoplasty was extended to the segmental level and the effect of the multi-segmental surgery for the central non-small lung cancer was observed. The involved lobular bronchi and part of main bronchi were resected and single-layer continuous suture with 5-0 Prolene was used for suturing of the carina of the reconstructed segmental bronchi to form lobular bronchi. Then, single-layer continuous suture with 4-0 Prolene was employed to anastomose the "lobular bronchi" with main bronchi.Our results showed that the 15 bronchoplasties were successfully performed. The tumors were completely removed and postoperatively, the pulmonary functions of the patients were substantially improved. No broncho-pleural fistula and stomal stenosis took place in all the cases. The quality of life of the patients were obviously improved. It is concluded that multisegmental bronchoplasty can completely remove the tumor of central non-small-cell lung cancer and conserve more non-involved lung.The procedure is especially suitable for those patients with severely impaired lung functions and it expands the indications of surgical resection of lung cancer.
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Objective To compare the efficacy between bronchial sleeve resection and bronchial wedge resection in the treatment of lung cancers.Methods The clinic datas of bronchial sleeve resection in 38 cases and bronchial wedge resection in 24 cases were analyzed,comparing the incindence of the fistulas on the anastomotic sites,early death,carcinoma cells on the bronchial edges,cancer recurrence on the anastomotic sites and survival rates between two groups.Results In the group of the bronchial sleeve resection,2 cases underwent the fistulas on the anastomotic sites,3 cases suffered death in the early period,2 cases residued carcinoma cells on the bronchial edges,1 case had scar hyperplasia on the anastomotic sites,1 case had cancers recurrence on the anastomotic sites.1 year,3 years,5 years survival rates were respectively 87.5%(28/32),60%(15/25),40%(4/10).In the group of the bronchial wedge resection,no cases underwent the fistulas on the anastomotic sites,2 cases suffered death in the early period,5 cases residued carcinoma cell on the bronchial edges,4 cases found scar hyperplasia on the anastomotic sites,3 cases having cancer recurrence on the anastomotic sites.1 year,3 years,5 years survival rates were respectively 85.7%(18/21),53.3%(8/15),42.9%(3/7).Conclusion Compared with bronchial sleeve resection in the treatment of lung cancers,the bronchial wedge resection increases the incindence of carcinoma cell on the bronchial edges and cancer recurrence on the anastomotic sites,but there is no difference in survival rate between them.
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BACKGROUND: Non-invasive interventional therapy has been performed for main bronchial obstruction by endobronchial tuberculosis because of the risk of main bronchial reconstruction regardless of the pulmonary function. But, effects of the interventional therapy are attacked by arguments. This study was aimed at interpreting the risk and effectiveness of bronchoplasty for benign bronchial stenosis over the last ten years in our hospital by reviewing the results based on clinical progression. MATERIAL AND METHOD: We retrospectively reviewed the clinical records and out-patient medical records including 21 consecutive patients who underwent main bronchial reconstruction for obstruction by endobronchial tuberculosis. All of them had past medical history of anti-tuberculosis medication. They were preoperatively evaluated by bronchoscopy and chest computed tomography. RESULT: There were no incidences of postoperative mortality and significant morbidity. There were 2 cases of retained secretions but these problems were resolved by therapeutic bronchoscopy or intubation. All of the patients are still alive without obstructive airway problem. CONCLUSION: Bronchoplasty should be considered as one of the primary treatment modalities, if it is anatomically feasible.
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Humans , Bronchi , Bronchial Diseases , Bronchoscopy , Constriction, Pathologic , Incidence , Intubation , Medical Records , Mortality , Outpatients , Retrospective Studies , Thorax , TuberculosisABSTRACT
Apresentamos um caso de tuberculose endobrônquica em uma mulher com 49 anos de idade. Em virtude da alta incidência de tuberculose infecção/doença em nosso meio e das sequelas que pode causar, os autores enfatizam a importância do exame andoscópico do aparelho respiratório no diagnóstico, tratamento e seguimento das lesões endobrônquicas.
A case of endobronchial tuberculosis is presented in a 49-year-old women patient. Considering the high tuberculosis infection/disease prevalence in our environment and the potential sequelae of this kind of tuberculosis, the authors emphasize the importance of the respiratory endoscopic examination for the diagnosis, treatment, and follow-up of endobronchial lesions.
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Humans , Female , Bronchoscopy/methods , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/therapyABSTRACT
Background and purpose:In recent years,sleeve resection of bronchus and pulmonary artery has been more extensively applied in treatments of lung cancer patients with poor pulmonary functions.This kind of surgery meets the basic surgical principles of lung cancer being maximum both in resecting the carcinoma of the lungs and preserving pulmonary functions,has a good prospect.Therefore,we summarize our recent experience in treating central type lung cancer by this method and discuss its principles and methods in the application of the surgical operation.Methods:From Dec.1993 to Dec.2003,63 patients with central type lung cancer underwent sleeve lobectomy of bronchus and pulmonary artery,including sleeve resection of bronchus and pulmonary artery in 43 cases,wedge resection of bronchus and pulmonary artery in 3 cases,sleeve resection of bronchus and wedge resection of pulmonary artery in 17 cases.The surgical procedures of sleeve resection included sleeve resection of right upper lobe and pulmonary artery in 20 cases,sleeve resection of left upper lobe and pulmonary artery in 23 cases,and the length of pulmonary artery that had been respected is from 1.5cm to(4.5cm),the average length is 2.5cm.The surgical procedures of wedge resection included wedge resection of right upper lobe and pulmonary artery in 2 cases, wedge resection of left upper lobe and pulmonary artery in 1 case.The group of sleeve resection of bronchus with wedge resection of pulmonary artery included sleeve resection of right upper lobe and wedge resection of pulmonary artery in 5 cases,sleeve resection of left upper lobe and wedge resection of pulmonary artery in 12 cases.Results:No case of death and anastomotic leak occurred.Conclusions:Because sleeve resection of bronchus and pulmonary artery can not only effectively resect the tumor but also maximally preserve the pulmonary function at the same time,it enlarges the surgical indications of lung cancer,and is an effective and safe method for the treatment of lung cancer.
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Objective To investigate value and effect of the bronchus was cut out and bronchoplasty for lung cancer. Methods Twenty-one patients with lung cancer which all invased out one bronchial orifice and precluded standard lobectomy. The present of endobronchial tumor was cut out according to the lesion region during operation, the bronchoplasty performed by health bronchial wall. Results There were squamous carcinoma in 15 patients; adenocarcinoma in 4; small cell lung cancer and carcinoid each one patient. Staging: stage Ⅰ in 3 patients; stage Ⅱ in 12, stage Ⅲa in 6. The 19 patients were uneventful after operation. The 2 cases died from acute pulmonary embolism or gastric irritable ulcer with large bleeding in perioperation. Respiratory failure in all patients had not occurred. Bronchoscopy performed immediately after operation in 16 patients and in the period of following up 6-36 months in 12 patients, the mucosa of bronchoplastic sites was smooth, no bronchial stenosis and no tumoral relapse.The period of following-up was 4-72 months, median survival 42 months after operation. Five patients died from the metastases or relapse. Life time in survival patients was well. Conclusion The bronchial resection by cut out and bronchoplasty for lung cancer had a good results in near future and long period, and proved individualized and adapted selective type of resection for bronchoplasty of lung cancer.
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Of the 49 patients(male 43, female 6) collected from October 1983 to April 2000, 46 were malignancy with 29 in TNM stage I, 15 in stage II, and 2 in stage Ⅲa. Age ranged from 10～68. Upper lobectomy with sleeve resection was performed in 43 cases(14 in left lung, 29 in right lung) and right upper lobectomy with wedge bronchoplasty in 2 cases, left upper lobectomy with bronchoplasty and angioplasty in 2 cases , left lower lobectomy with sleeve resection in 2 cases. There was no mortality in our group and all patients recovered well. No such major complications as bronchial anastomotic fistula or stenosis occurred. The 1,5 and 10 year survival rates of malignant cases were 93.0%, 48.1% and 8.3% respectively. The results suggested that the operation plan for malignant lung diseases should be made individually. However, instead of a total pneumonectomy, a sleeve lobectomy is sometimes preferabe for the sake of the safety in those with poor cardiopulmonary function to save the lung capacity as much as possible.
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A case of endobronchial tuberculosis with left main bronchial stenosis and atelectasis of left lower lobe in a 26-year-old female is reported. She had taken antituberculous agents for 9 months, but she complained of chest pain and coughing. Bronchoscopy revealed patency of left upper bronchus and bronchiectasis of left lower lobe. She underwent left lower lobectomy with bronchoplasty. After the operation she had significant improvement of pulmonary function. Although surgical treatment of endobronchial tuberculosis is controversial, bronchoplastic surgery can be an effective treatment of tuberculous bronchial stenosis because it relieves patients from symptoms by preserving lung functions.
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Adult , Female , Humans , Bronchi , Bronchiectasis , Bronchoscopy , Chest Pain , Constriction, Pathologic , Cough , Lung , Pulmonary Atelectasis , TuberculosisABSTRACT
BACKGROUND: Various bronchoplastic procedures have been attempted in patients with long segmental bronchial stenosis, but it is still not clear which procedure is the best method for restoring bronchial patency. MATERIAL AND METHOD: To study the feasibility of designed patch as a bronchial substitute in bronchoplastic procedure, 10 experimental dogs of each 5 were divided into two groups according to the different patches applied. In group A (n=5), 0.5X0.5 cm sized rectangular defects were created on ventral aspect of left main bronchus and were then covered with patches made of costal cartilage mounted autologous pericardium. In group B(n=5), same sized bronchial defects were created and covered by patches made by glutaraldehyde treated bovine pericardium. Dogs were sacrificed on the twelfth weeks after bronchoplasty and the macroscopic and microscopic findings were examined. RESULT: In group A, external surface of grafted patches revealed some membranous adhesions with surrounding connective tissue and the margin of patches were smoothly incorporated into native bronchial wall. The bronchial lumen kept good integrity without stenosis and preserved the glistening mucosa well. Formation of new transitional epithelial bridging between native bronchial wall and grafted patches with tiny scattered granulation tissues were present. In group B, external surface of grafted patches were brownish shrunken with partial collapse of bronchial lumen. Inner surface showed dirty granulation at the edge of native bronchus and grafted patches with intermingled hemorrhages. New epithelial growth into the patches had not occurred. CONCLUSION: These results suggest that costal cartilage mounted autologous pericardial patches could be considered as one of the appropriate bronchial substitutes for covering bronchial defects since it maintains bronchial stability and forms epithelial bridging with native bronchus.
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Animals , Dogs , Humans , Bronchi , Cartilage , Connective Tissue , Constriction, Pathologic , Glutaral , Granulation Tissue , Hemorrhage , Mucous Membrane , Pericardium , TransplantsABSTRACT
Leiomyoma of the bronchus is a very rare, benign tumor of the lung. We herein report a case of endobronchial leiomyoma which was treated by sleeve bronchoplasty without resection of the lung and without any complications. A 35-year-old man was admitted to our hospital complaining of stridor. Bronchoscopy revealed a round, hypervascular and smooth tumor nearly obstructing the left main bronchus at 1.5 cm distal portion from the carina. Biopsy was not performed for fear of massive hemorrhage. A sleeve resection of left main bronchus including the tumor and end-to-end anastomosis were performed. The histologic diagnosis was leiomyoma. The early diagnosis and appropriate surgical treatment to preserve the pulmonary function are important points of consideration.