Carinal Resection and Sleeve Pneumonectomy Using a Transsternal Approach

Abstract

Carinal resection, with or without concomitant pulmonary resection is a relatively recent addition to the thoracic surgical armamentarium. Initially, partial-wall tracheal resections were carried out with autogenous or prosthetic material patches (eg, wire, polypropylene mesh) and were first reported by Belsey in 1946.’ The first carinal resection with primary reconstruction was described by Barclay et al’ in the management of a cylindroma. In this first case report, an end-to-end anastomosis was performed between the trachea and right mainstem bronchus with reimplantation of the left mainstem bronchus into the side of the bronchus intermedius. During the past 30 years, significant contributors to the carinal resection technique have included Gril10,~ per el ma^^,^ Pearson,j Jensik,6 Eschapassel7 Dartevelle,8 and Deslauriers.’ The approaches to the carina include a transsternal or a right posterolateral thoracotomy approach. Only on rare occasions (usually unanticipated) should a left sleeve pneumonectomy be attempted using a left posterolateral thoracotomy incision. Indications