How different surgical methods of performing right upper lobectomy contribute to postoperative bronchial branching deformity: an experimental study.

Abstract

It has been suggested that postoperative bronchial deformity is a complication of surgery and that the surgical methods employed may play a role in its development. We studied the relationship between postoperative bronchial branching deformity and various surgical methods, including hand suturing or mechanical stapling of right upper (RU) lobectomy, versus wedge or sleeve bronchoplasty with RU lobectomy. We used an in situ bronchial casting model in rabbits and measured the branching angles between: the trachea and the right main bronchus (RMB); the trachea and the left main bronchus; the RMB and the intermediate bronchus (IB); the IB and the right middle lobe bronchus (RMLB); and the RMLB and the coronal plane. In the mechanical stapling group, the angle between the RMB and the IB was wider than in the hand suturing group, and the RMLB diverged more laterally. In the wedge plasty group, the angle between the trachea and the RMB was wider, while that between the IB and the RMLB was narrower than in the hand suturing group. In the sleeve plasty group, the angle between the RMB and the IB and that between the IB and the RMLB were wider than in the hand suturing group. The findings of this experiment clearly demonstrate that postoperative deformity of the distal bronchus varies according to the surgical methods used.