Bronchial Reconstruction Research Articles

Right Middle Lobectomy on Metallic Foreign Body Using the Uniportal Video Assisted Thoracoscopic Surgery: A First Experience in the Democratic Republic of Congo

The removal of metallic foreign bodies in the lower airways, a source of recurrent pneumonia, is not currently performed in the Congolese population using video-assisted thoracoscopy surgery (VATS) under unipulmonary ventilation. Multiple failures of rigid and/or flexible bronchoscopy are likely to be a cause of morbidity and mortality. To the best of our knowledge, we report a first experience in DRC, of right middle lobectomy on metallic foreign body by VATS in a 14-year-old girl after two years of accidental inhalation of a metallic key, in the face of two bronchoscopy failures. A partial transverse bronchotomy successfully performed under VATS allowed extraction of the foreign body followed by bronchial reconstruction with resection of the right middle lung lobe. The aim of the multidisciplinary team was to determine whether lobectomy by VATS would result in shorter hospital stays, fewer complications and faster recovery than lobectomy by thoracotomy, to review the key stages of case management using an unusual approach in the region, and to draw a conclusion based on this first experience.

Intraoperative minimally invasive left bronchial reconstruction using a pericardial flap during robot-assisted esophagectomy.

Intraoperative minimally invasive left bronchial reconstruction using a pericardial flap during robot-assisted esophagectomy.

Techniques and outcomes of bronchoplastic and sleeve resection: an 8-year single-center experience.

BackgroundBronchial reconstruction is one of the most challenging procedures for thoracic surgeons. This study aimed to report the surgical techniques and clinical outcomes of bronchoplastic and sleeve resection for central lung cancer and summarize our center’s experience of this challenging procedure over the past 8 years.MethodsBetween January 2013 and April 2021, 54 patients underwent a sleeve resection or a lobectomy with bronchoplasty, including 11 patients who received video-assisted thoracoscopic surgery (VATS) bronchial sleeve resection (4 via the uniportal approach and 7 via the biportal approach). Perioperative parameters and surgical short-term patient outcomes were analyzed to evaluate the safety and feasibility of this surgical procedure.ResultsThe average operative time and blood loss were 247.8±73.1 (range, 126–455) minutes and 300.4±321.8 (range, 50–1,500) mL, respectively. The mean postoperative length of stay was 10.5±5.8 (range, 4–29) days. Eleven patients underwent additional pulmonary angioplasty or sleeve resection. For patients who underwent biportal VATS sleeve lobectomy, the median operative time was 255 (interquartile range, 179–360) minutes, the median blood loss was 200 (interquartile range, 100–600) mL, and the median postoperative hospital stay was 5 (interquartile range, 5–8) days. For patients who underwent uniportal VATS sleeve lobectomy, the median operative time was 288 (interquartile range, 241.5–343) minutes, the median blood loss was 75 (interquartile range, 50–100) mL, and the median postoperative hospital stay was 5 (interquartile range, 4.5–5.5) days. No anastomosis-related complications or perioperative mortality was observed.ConclusionsBoth bronchoplastic resection and sleeve resection are safe and feasible procedures. Uniportal thoracoscopic sleeve lobectomy can be performed by skilled surgeons with satisfactory short-term outcomes, although it is surgically complicated.

Surgical outcomes of segmental bronchial sleeve resection in central non-small cell lung cancer.

BackgroundThe purpose of this study was to present the clinical and surgical results in patients who underwent segmental bronchial sleeve reconstruction.MethodsThe clinical and pathological data of 16 patients with central non‐small cell lung cancer (NSCLC) who underwent segmental bronchial sleeve resection from April 2015 to May 2019 were retrospectively analyzed.ResultsAccording to the type of segmental bronchial reconstruction, procedures were divided into four types: right upper S6 sleeve lobectomy in three cases (type A); left lower lingular sleeve lobectomy in 10 cases (type B); left upper S6 sleeve lobectomy in two cases (type C); and left lower propriolateral superior sleeve lobectomy in one case (type D). A total of three patients (18.75%) experienced anastomotic complications, including two with anastomotic stenosis and one with anastomotic fistula. All patients achieved R0 resection. Apart from one patient who died of acute lung infection after surgery, the rest were successfully discharged. The average follow‐up time was 28 months, and the overall survival rates of patients at one, two, and three years were 80.0%, 53.3%, and 40.0%, respectively.ConclusionsSegmental bronchial sleeve resection is complex in technique and may have an increased risk of complications compared to a standard sleeve resection, but it is an effective and safe procedure, especially for selected patients with central lung cancer.

EP1.18-15 Surgical Results of Primary Mucoepidermoid Carcinoma of Lungs: A 9 Years' Experience

Pulmonary mucoepidermoid carcinoma is a rare salivary-gland type lung cancer and accounts for 0.1%–0.2% of all primary lung malignancies. The optimal treatment of pulmonary mucoepidermoid carcinoma is not well determined. The aim of this study was to examine the surgical outcomes for the pulmonary mucoepidermoid carcinoma in our institution. From January 2010 to December 2018, we performed a retrospective review including all patients with primary pulmonary mucoepidermoid carcinoma of lung who underwent pulmonary resections in our institutions. The patients’demographic, clinical, and survival data were analyzed. A total of 3124 primary lung cancer patients underwent surgical resections by the same surgical team during the 8-year study period. 8 cases (0.25%) patients who were diagnosed with primary mucoepidermoid carcinoma of the lung were analyzed in this study. The patients’ characteristics are shown in Table 1. The median age of all patients was 57 year-old (range: 22-75 year-old). Cough is the most common symptom (5 cases, 62.5%). 7 cases had a low-grade tumor, and all the cases were completely resected thoracoscopically. Two cases were resected by wedge resection because peripherally located, and two cases required bronchial reconstruction. There was no adverse effect after the operation. One case recived adjuvent chemotherapy due to nodal invasion. However, this case had disease progression with patella bone metastasis 5 months after opeartion. The other cases were free of malignancy with a median follow-up of 27.2 months. Complete surgical resection of a mucoepidermoid carcinoma of lungs can be atributed to a long-term survival in patients. For an elederly patient with a peripherally located tumor, wedge rsection with mediastinal lymphnode dissection could be an alternative treatment.

AB008. Prosthetic tracheal replacement using stented aortic matrices

: Airway transplantation remains a great surgical and biological challenge. This is still an unsolved problem for patients in therapeutic impasse because of major tracheobronchial lesions requiring surgical resection and airway reconstruction. Schematically, 5 principal ways of research have been explored with the use of synthetic prostheses, airway bio-prostheses, tracheal allografts, various autologous substitutes and more recently bio-engineered conduits. The lack of prospective human studies did not allow standardizing surgical approaches. In 1997, we initiated a research program on airway transplantation using stented aortic matrices in the Laboratory of the Alain Carpentier Foundation, Paris. A series of 7 preclinical animal studies using a sheep model showed that autologous and fresh or cryopreserved allogeneic aortic grafts could be valuable tracheal, carinal and bronchial substitutes. The regeneration of epithelium and de novo generation of cartilage were observed within the aortic matrices, thus allowing stent removal at a mean of 6 months. These favorable results led to the first human applications in patients with extensive tracheal diseases or complex tumors that would otherwise require pneumonectomies. Recently, we confirmed that airway bioengineering using cryopreserved aortic allografts was feasible for complex tracheal and bronchial reconstruction in 13 human cases (Martinod et al. Feasibility of bioengineered tracheal and bronchial reconstruction using stented aortic matrices. JAMA 2018;319:2212-22). Twenty patients were prospectively included in the TRACHEOBRONCART study. Thirteen patients underwent tracheal (n=5), bronchial (n=7), or carinal (n=1) replacement. Airway transplantation was not performed in 7 patients because of medical contraindication (n=1), unavoidable pneumonectomy (n=1), exploratory thoracotomy only (n=2), and a lobectomy or bilobectomy was possible (n=3). The overall 90-day mortality rate was 5%. There was no mortality at 90 days among patients who underwent tracheal or bronchial reconstruction. The only mortality was observed in the patient who had a massive stroke after carinal transplantation. There was no adverse event directly related to the innovative surgical technique. Stent removal was performed at a postoperative mean of 18.2 months. At a median follow-up of 3 years 11 months, 10 of the 13 patients were alive. Of these 10 patients, 8 breathed normally through newly formed airways after stent removal. Regeneration of epithelium and de novo generation of cartilage were observed within aortic matrices from recipient cells. We confirmed in human the possibility of epithelium regeneration, de novo cartilage generation and stent removal. Our previous work has shown that the −80 °C cryopreserved aortic allografts contained viable cells at time of implantation, as assessed by their ability to migrate and proliferate from explants. They released a large panel of cytokines and growth factors and exerted significant chemoattractant and proangiogenic effects toward endothelial cells when assessed in vitro. Thus, cells from cryopreserved aortic allografts could have orchestrated the regenerative process by stimulating progenitor/stem cell homing and organ healing. The recipient body was used as a natural bioreactor and allowed in vivo airway tissue engineering. After approval by French Regulatory Authorities (Assistance Publique Hôpitaux de Paris DRCD and DAJ), we started the prospective observational study TRITON01 (TRacheobronchial bIoengineering using aorTic matrices for airway recONstruction) as a part of routine care for our center. We used the same innovative surgical approach as the previous protocol (NCT01331863, clinicaltrials.gov identifier) published by our group. Seven new patients with a therapeutic impasse have been added to the study since March 13, 2019. Our principal objectives are to include prospectively new patients with end-stage tracheobronchial diseases (TRITON 01 study); to compare airway transplantation using stented cryopreserved aortic allografts to standard therapy in patients with a major thyroid cancer invading the trachea (TRITON 02 study); to decipher the mechanisms of de novo cartilage regeneration and immunoregulation within transplanted aortic matrices; to optimize de novo cartilage regeneration using in vitro preconditioning of cryopreserved aortic allografts or in vivo local injection of mesenchymal stem cells; and finally to test new types of bioengineered and/or 3D printed aortic grafts with a commercial potential for a wider dissemination.

Video - Assisted Thoracic Bronchial Reconstruction Surgery for Patients with Lung Cancer: Protocol of a Systematic Review

Video-Assisted Thoracic Bronchial Reconstruction surgery is an advance complex procedure and are technically well described, however oncological efficacy is not well established in thoracic surgery. Objective: To evaluate the effectiveness of VATS bronchoplasties in patients with lung cancer. Method We will conduct a systematic review of all eligible analytic study designs on bronchoplastic video assisted thoracic surgery for patients with lung cancer according to the PRISMA guidelines; which will cover the last two decades, including: 1) published studies reporting outcomes of VATS- bronchoplasty for lung cancer; 2) no limited language restriction; 3) references list on case report and review articles of VATS-bronchoplasty for lung cancer were also searched; 4) containing original data; 5) including > 10 adult patients. Databases from: MEDLINE through PubMed, CINAHL, and Cochrane will be the bases platforms for our research. For grey literature, we will search LILACS, OpenGrey, and Google Scholar. For each key concept, appropriate free-text words and Medical Subject Headings (MeSH) will be developed. Risk of bias will be assessed through the QUIPS tool. We will report our findings in a narrative synthesis alongside developing a preliminary synthesis of findings of included studies; exploring relationships within and between studies; providing a description and synthesis of the results. And assessing the robustness of the synthesis. For quantitative data, where possible, a meta-analysis will be considerate if there are no different research designs due to diversity in the evidence base used to consolidate it; odds ratio or standardized mean differences and their 95% confidence intervals will be calculated from the data generated by each included study. Ethics and dissemination: Formal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication.

Результати застосування органозберігаючих операцій при захворюваннях та пошкодженнях бронхів

Результати застосування органозберігаючих операцій при захворюваннях та пошкодженнях бронхів

Feasibility of Bioengineered Tracheal and Bronchial Reconstruction Using Stented Aortic Matrices

Airway transplantation could be an option for patients with proximal lung tumor or with end-stage tracheobronchial disease. New methods for airway transplantation remain highly controversial. To establish the feasibility of airway bioengineering using a technique based on the implantation of stented aortic matrices. Uncontrolled single-center cohort study including 20 patients with end-stage tracheal lesions or with proximal lung tumors requiring a pneumonectomy. The study was conducted in Paris, France, from October 2009 through February 2017; final follow-up for all patients occurred on November 2, 2017. Radical resection of the lesions was performed using standard surgical techniques. After resection, airway reconstruction was performed using a human cryopreserved (-80°C) aortic allograft, which was not matched by the ABO and leukocyte antigen systems. To prevent airway collapse, a custom-made stent was inserted into the allograft. In patients with proximal lung tumors, the lung-sparing intervention of bronchial transplantation was used. The primary outcome was 90-day mortality. The secondary outcome was 90-day morbidity. Twenty patients were included in the study (mean age, 54.9 years; age range, 24-79 years; 13 men [65%]). Thirteen patients underwent tracheal (n = 5), bronchial (n = 7), or carinal (n = 1) transplantation. Airway transplantation was not performed in 7 patients for the following reasons: medical contraindication (n = 1), unavoidable pneumonectomy (n = 1), exploratory thoracotomy only (n = 2), and a lobectomy or bilobectomy was possible (n = 3). Among the 20 patients initially included, the overall 90-day mortality rate was 5% (1 patient underwent a carinal transplantation and died). No mortality at 90 days was observed among patients who underwent tracheal or bronchial reconstruction. Among the 13 patients who underwent airway transplantation, major 90-day morbidity events occurred in 4 (30.8%) and included laryngeal edema, acute lung edema, acute respiratory distress syndrome, and atrial fibrillation. There was no adverse event directly related to the surgical technique. Stent removal was performed at a postoperative mean of 18.2 months. At a median follow-up of 3 years 11 months, 10 of the 13 patients (76.9%) were alive. Of these 10 patients, 8 (80%) breathed normally through newly formed airways after stent removal. Regeneration of epithelium and de novo generation of cartilage were observed within aortic matrices from recipient cells. In this uncontrolled study, airway bioengineering using stented aortic matrices demonstrated feasibility for complex tracheal and bronchial reconstruction. Further research is needed to assess efficacy and safety. clinicaltrials.gov Identifier: NCT01331863.

Extended right upper sleeve lobectomy with double-barrel segmental bronchoplasty.

Extended sleeve lobectomy (ESL), which is defined as the atypical sleeve resection of more than one lobe, has been widely accepted to preserve the pulmonary function (1-3). Double-barrel anastomosis has been reported as a method of bronchial reconstruction after carinal resection; however, it is rarely applied in the reconstruction of segmental bronchi. We herein report a case in which ESL with double-barrel anastomosis of the middle lobar bronchus (MLB) and basilar bronchus (BB) was successfully applied in the treatment of a patient with centrally located lung adenocarcinoma.

Bronchial Mismatch as a Predictor of Respiratory Failure After Congenital Tracheal Stenosis Repair

The purpose of this study was to identify predictors of postoperative respiratory failure after surgical tracheoplasty for congenital tracheal stenosis. Between February 2011 and April 2017, 16 infants underwent congenital tracheal stenosis repair. Preoperative computed tomography evaluation of the trachea and mainstem bronchi was performed. The primary outcome was midterm freedom from postoperative respiratory failure defined as persistent need for mechanical ventilation or surgical tracheobronchial reoperation. Bronchial mismatch, defined as [1- (smaller bronchus diameter / larger bronchus diameter)]× 100, was analyzed in relation to the primary outcome. Median age was 106 days (range, 1 to 406) and median weight was 5.3 kg (range, 2.6 to 8 kg). Four patients were neonates (25%) and 6 had genetic abnormalities (37.5%). There were no early nor late deaths. Median ventilation time was 5.5 days (range, 3 to 45). Mean follow-up time was 2.2 years (range, 0.1 to 4.5). Four patients with bronchial mismatch greater than 20% had postoperative respiratory failure (p= 0.002). Two of them underwent tracheostomy and were discharged with ventilation home care support. One underwent successful reoperation consisting of bilateral bronchial plasty with autologous cartilage rib grafts, and the other underwent successful right bronchial and tracheal reconstruction. One patient with bilateral bronchial hypoplasia underwent slide tracheoplasty associated with preemptive bilateral bronchial plasty and made a full recovery. Surgical treatment of congenital tracheal stenosis in neonates and infants portends a good outcome. Bronchial mismatch greater than 20% can identify a subset of patients at increased risk for surgical reintervention and chronic respiratory failure. Slide tracheoplasty with preemptive bronchial reconstruction may prevent postoperative respiratory failure.

Clinical Experience of Thoracoscopic Sleeve Lobectomy Using a Novel Needle Holder

Thoracoscopic bronchoplasty requires high technique to control stitching during bronchial reconstruction. Improved quality of suturing instrument may contribute to overcome this difficulty of bronchial anastomosis. Recently, a unique and expected articulated instrument for suturing has been launched on endoscopic surgery. We have successfully performed two cases of thoracoscopic sleeve lobectomy using this instrument.

Left side sleeves

Left bronchial sleeve resection is a particular surgical technique sometimes required for treating lung cancer arising at the origin of a lobar bronchus. In some cases, this technique is required for resecting a neoplastic hilar node infiltrating the upper left bronchus. In some instances, these neoplastic lesions may infiltrate also the pulmonary artery requiring a double sleeve resection (bronchial and arterial) and reconstruction in order to preserve as much lung parenchyma as technically and oncologically possible. Bronchial reconstruction (the anastomosis between the main left bronchus and the left lower bronchus) is performed with two running sutures with a non-absorbable monofilament in order to obtain a telescopic anastomosis. PA can be infiltrated by the tumor to various levels, from partial infiltration to a more extensive and even circumferential involvement. In case of partial involvement, a partial resection with suture of the PA is indicated; in case of extended involvement, the reconstruction of the PA may be made by using pericardial patch, end-to-end anastomosis, or by the interposition of a prosthetic conduit. In this review, we report our experience in treating lung cancer infiltrating the left pulmonary artery and the left upper bronchus requiring a double sleeve resection and reconstruction. We also describe the workup of these patients and we illustrate in details our surgical technique.

Uniportal video-assisted thoracoscopic bronchovascular, tracheal and carinal sleeve resections†.

Locally advanced lung tumours often require complex surgical techniques to achieve an oncological and safe procedure. Sleeve resections when operating on endobronchial lesions or hilar tumours should be attempted whenever possible rather than performing a pneumonectomy. These procedures result in improved survival, better quality of life, a reduced loss of lung function and an improved operative mortality compared with pneumonectomy. Although the most common approach is an open thoracotomy, these complex surgical techniques can be performed in a thoracoscopic way with the skills and the experience gained from major video-assisted thoracoscopic procedures (VATS). However, despite the multiple advantages of VATS compared with thoracotomy, such as decreased postoperative pain and better recovery, this minimally invasive approach is still not widely adopted for advanced stages of lung cancer and complex resections. Concerns about performing an adequate oncological resection and safe reconstruction VATS are the main reasons for the low adoption of these minimally invasive approaches. Like other thoracoscopic techniques, VATS sleeve procedures also have a steep learning curve, and should therefore be performed either by or with skilled and experienced VATS surgeons to ensure safety and avoid complications. In this article, we describe the technique of thoracoscopic sleeve procedures through a single-incision (uniportal) approach for bronchial, bronchovascular, tracheal and carinal reconstruction, and review the literature reporting sleeve resections by VATS.

Flap bronchoplastyを用いたLow-grade mucoepidermoid carcinomaのS<sup>6</sup>区域切除の1例

本邦の原発性肺悪性腫瘍手術の中で気管支形成術の割合は1.7%と報告されている．今回比較的稀な術式であるFlap bronchoplastyを経験したので報告する．症例は11歳，女児．繰り返す肺炎を契機に発見させた腫瘍性病変であり，中間気管支幹内腔を占拠していた．気管支鏡下生検で当初乳頭腫の診断を得たため良性腫瘍と判断し硬性鏡下Core-outにより腫瘍摘出術を行った．最終病理診断でLow-grade mucoepidermoid carcinomaの診断を得て気管支鏡でB6と底区気管支分岐部のB6側に腫瘍の基部を確認したところ腫瘍遺残を認めた．以上より追加切除が必要と判断しB6と底区気管支分岐部のwedge resectionを伴うS6区域切除を行い，B6気管支壁片（B6 bronchial flap）を利用した下葉気管支欠損部再建術を施行した．①腫瘍基部がB6と底区気管支の分岐部に限局，②術前にLow-grade粘表皮癌と診断された症例において，B6 bronchial flapを利用したFlap bronchoplasty（S6区域切除）は縮小手術の術式として有用であった．

Extracorporeal membrane oxygenation as a support for emergency bronchial reconstruction in a traumatic patient with severe hypoxaemia: Figure 1:

Extracorporeal membrane oxygenation (ECMO) is an extracorporeal life support technique to provide cardiac and/or respiratory assistance to patients. ECMO has been demonstrated to be beneficial for the life support of selected traumatic individuals. However, the application of arteriovenous ECMO as an intraoperative support strategy in emergency operations has rarely been described. The presented case involves a 31-year old male who sustained a right bronchial rupture and other multiple injuries in a car accident. His right main bronchus was sewn completely closed during the first operation in a local hospital, and he developed refractory hypoxaemia and haemodynamic instability. Although general anaesthesia was not applicable, arteriovenous ECMO was applied as a support to perform the second operation to reconstruct successfully his right main bronchus. As a result, he recovered from this injury.

Long-term results after resection of bronchial carcinoid tumour: evaluation of survival and prognostic factors.

We retrospectively analysed morbidity, mortality and oncological results of patients who had undergone surgery for bronchial carcinoid tumours. Between 2002 and 2012, 65 patients with bronchial carcinoids underwent lobectomy (n = 34), sublobar resection (segmentectomy/wedge) (n = 18), sleeve lobectomy (n = 5) (reconstruction of the pulmonary artery was associated in 1 case), sleeve resection of the main bronchus (n = 4) or pneumonectomy (n = 4) (reconstruction of the carina was associated in 1 case). Resection was radical with histologically negative margins in all patients (R0). Histology showed typical carcinoid (TC) in 55 (84.6%) patients and atypical carcinoid (AC) in 10 (15.4%) patients. Final pathological stages were Stage I in 42 (64.6%) patients, Stage II in 18 (27.7%) and Stage III in 5 (7.7%). No postoperative mortality was observed. The postoperative morbidity rate was 15.4% (no bronchial and/or vascular reconstructive-related complications occurred). The median follow-up was 58 (range 2-121) months. The overall recurrence rate was 12.3% (n = 8). The survival rate at 5 years was 100% for TC and 87% for AC. Disease-free survival rates at 3 and 5 years were 95 and 93% for TC and 78 and 44% for AC, respectively (P = 0.004). Pathological nodal involvement (pN1-N2) did not affect overall survival or recurrence. The surgical treatment of bronchial carcinoids provides high long-term survival rates. Low postoperative morbidity and mortality can be expected even after bronchial reconstruction. The AC appears to be the main factor that determines the risk of recurrence. Bronchial reconstructive lung sparing operations are not related to an increased recurrence rate.

Bronchiolitis obliterans associated with Stevens-Johnson Syndrome: histopathological bronchial reconstruction of the whole lung and immunohistochemical study

This study presents an extremely rare case of constrictive bronchiolitis obliterans (BO) associated with Stevens-Johnson Syndrome (SJS) provides the morphological and immunohistochemical features using histopathological bronchial reconstruction technique. A 27-year-old female developed progressive dyspnea after SJS induced by taking amoxicillin at the age of 10. Finally, she died of exacerbation of type II respiratory failure after 17 years from clinically diagnosed as having BO. Macroscopic bronchial reconstruction of the whole lungs at autopsy showed the beginning of bronchial obliterations was in the 4th to 5th branches, numbering from each segmental bronchus. Once they were obliterated, the distal and proximal bronchi were dilated. Microscopic bronchial reconstruction demonstrated the localization of obliteration was mainly from small bronchi to membranous bronchioli with intermittent airway luminal narrowing or obliteration. Moreover, CD3-, CD20-, and CD68-positive cells were found in the BO lesions. CD34- and D2-40-positive cells were mainly distributed in the peribronchiolar lesions and bronchiolar lumens, respectively. SMA- and TGF-β-positive cells were seen in the fibrous tissue of BO lesions.The virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1071703140102601.

Histopathological bronchial reconstruction of human bronchiolitis obliterans

To clarify the morphological mechanisms of airway obliteration in bronchiolitis obliterans (BO) associated with various causes, we conducted a retrospective study of 9 patients with a histological diagnosis of BO. The morphological characteristics were analyzed by histopathological bronchial reconstruction. BO was classified into two major morphologic subtypes: constrictive BO (CoB) and cellular/destructive BO (CDB). CoB is characterized by concentric narrowing of the airway lumen due to submucosal fibrosis. In contrast, in CDB the narrowing of the airway lumen is due to intraluminal, mural, and peribronchiolar infiltration of inflammatory cells as well as proliferation of granulation tissue. The histopathological diagnosis was CoB in 6 patients and CDB in 3 patients. Macroscopic bronchial reconstruction in CoB demonstrated that the beginnings of bronchial obliterations were in the 4th to 7th branches, numbering from each segmental bronchus and the lesions were distributed intermittently. Histopathologically, the localization of obliteration was mainly from small bronchi to membranous bronchioli with intermittent airway luminal obliteration in CoB, whereas the primary lesions in CDB revealed more continuous obliteration of the bronchiolar lumen than observed in CoB. In conclusion, this bronchial reconstruction study demonstrated marked morphological differences in the mechanisms of airway obliteration between two major morphologic subtypes of BO.

Apnoeic oxygenation on one-lung ventilation in functionally impaired patients during sleeve lobectomy

We describe a useful salvage method for hypoxaemia during one-lung ventilation (OLV) in functionally impaired patients during a sleeve bronchial reconstruction. When dependent-lung OLV strategies for hypoxaemia fail during bronchial anastomosis (increasing the oxygen administration to fraction of inspired oxygen (FiO(2)) 1 and positive end-expiratory pressure (PEEP), recruitment strategy and perfusion modulation), a very simple and efficient method for oxygen administration to the non-dependent lung can be easily employed. Oxygen flow of 5-10 l min(-1) administered by a paediatric intra-field catheter placed in the distal bronchi during bronchial anastomosis of the spared lobe(s), following the principles of apnoeic (hyper)oxygenated ventilation, successfully improves oxygenation without significant impairment of the operation field.