Bronchial Resection Research Articles

Comparative Study of Indocyanine Green Intravenous Injection and the Inflation-Deflation Method for Assessing Resection Margins in Segmentectomy for Lung Cancer: A Single-Center Retrospective Study.

The inflation-deflation (ID) method has long been the standard for intraoperative margin assessment in segmentectomy. However, with advancements in vision technology, the use of near-infrared mapping with indocyanine green (ICG) has become increasingly common. This study was conducted to compare the perioperative outcomes and resection margins achieved using these methods. This retrospective study included patients who underwent direct segmentectomy for clinical stage I lung cancer between January 2018 and September 2022. We compared perioperative factors, including bronchial and parenchymal resection margins, according to the margin assessment method and the type of segmentectomy performed. Since the ICG approach was adopted in April 2021, we also examined a recent subgroup of patients treated from then onward. A total of 319 segmentectomies were performed. ID and ICG were utilized for 261 (81.8%) and 58 (18.2%) patients, respectively. Following April 2021, 61 patients (51.3%) were treated with ID, while 58 (48.7%) received ICG. We observed no significant difference in resection margins between ID and ICG for bronchial (2.7 cm vs. 2.3 cm, p=0.07) or parenchymal (2.5 cm vs. 2.3 cm, p=0.46) margins. Additionally, the length of hospitalization and the complication rate were comparable between groups. Analysis of the recent subgroup confirmed these findings, showing no significant differences in resection margins (bronchial: 2.6 cm vs. 2.3 cm, p=0.25; parenchymal: 2.4 cm vs. 2.3 cm, p=0.75), length of hospitalization, or complication rate. The perioperative outcomes and resection margins achieved using ID and ICG were comparable, suggesting that both methods can safely guide segmentectomy procedures.

The overview of the performed robot-assisted minimally invasive bronchial resection with primary anastomosis for schwannoma arising from left main bronchus.

The overview of the performed robot-assisted minimally invasive bronchial resection with primary anastomosis for schwannoma arising from left main bronchus.

Uniportal VATS right main bronchus resection and double carinal reconstruction

Uniportal VATS right main bronchus resection and double carinal reconstruction

Clinical Outcomes of Preserving Bronchial Arteries During Radical Esophagectomy: A Propensity-Score Matched Analysis.

Postoperative pneumonia is a common and major cause of mortality after radical esophagectomy. Intraoperative preservation of the bronchial arteries is often aimed at avoiding tracheobronchial ischemia; however, it is unknown whether this contributes to a reduction in postoperative pneumonia. We enrolled 348 consecutive patients who underwent radical esophagectomy for esophageal cancer at Toranomon Hospital from January 2011 to July 2018. We classified patients into a bronchial artery-resected (BA-R) group (n = 93) and a bronchial artery-preserved (BA-P) group (n = 255) and compared the incidence of postoperative pneumonia between the two groups. A propensity score-matching analysis for bronchial artery preservation versus resection was performed. Overall, 182 patients were matched. Univariate analysis of the propensity score-matched groups showed that Brinkman index ≥ 400, vital capacity (%VC) < 80%, and bronchial artery resection were associated with the development of postoperative pneumonia. Multivariate analysis revealed three significant factors associated with postoperative pneumonia: Brinkman index ≥ 400 [p = 0.006, odds ratio (HR) 3.302, 95% confidence interval (95% CI) 1.399-7.790], %VC < 80% (p = 0.034, HR 6.365, 95% CI 1.151-35.205), and bronchial artery resection (p = 0.034, HR 2.131, 95% CI 1.060-4.282). The incidence of postoperative complications (CD grade III) was higher in the BA-R group (BA-R 42.8% versus BA-P 27.5%, p = 0.030). There was no significant difference in overall survival between the two groups at 5 years (BA-R 63.1% versus BA-P 72.1%, p = 0.130). Preserving the bronchial artery is associated with a decreased incidence of postoperative pneumonia.

The Significance of Reconstructive Tracheal and Bronchial Surgery in the Context of Malignant Pulmonary Tumours

Lung cancer holds a prominent position in the malignant mortality rates. Despite the rapid advancement of pharmacological approaches to the lung malignancy treatment, surgical interventions remain relevant and pertinent in contemporary practice. The choice of an appropriate therapy for local lung cancer presents a particularly acute dilemma. This issue gives rise to contradictions as it necessitates a tailored approach for each individual case. In such instances, the only radical treatment methods for lung cancer involve surgical interventions, namely pneumonectomy and lobectomy/bilobectomy. The preference leans towards lobectomy, given that this choice mitigates disability, thereby enhancing the patient's quality of life. Organ-preserving surgery holds a distinct significance for patients with compromised functional reserves, where complete lung resection is intolerable. However, at the time of identifying centrally located lung neoplasms, tumors or metastatic lymph nodes often extend to the orifices of the segmental and main bronchi. A lobectomy is feasible only with the resection (wedge-shaped or circumferential one) of the main bronchus and subsequent bronchoplasty. Tumor invasion of the pulmonary artery presents a formidable obstacle to organ-preserving surgery.In cases where pneumonectomy is intolerable, bronchoangioplastic lobectomy/bilobectomy stands as the sole viable radical intervention. Pneumonectomy with wedge-shaped or circumferential resection of the trachea, followed by tracheobronchoplasty, represents one of the most intricate procedures in thoracic surgery. However, when the tumor extends to the tracheal bifurcation, only this operation allows for a radical surgical approach. Notably, in circumstances where the tumor (carcinoid) affects the main bronchus, partial circumferential bronchial resection with subsequent bronchoplasty becomes feasible. Thus, the entire pulmonary ventilation capacity is preserved. Clinical observations of such procedures have been documented in patients with diminished functional reserves.

Distance between tumor and bronchial resection margin is an independent predictor of recurrence-free survival and overall survival in primary endobronchial neoplasm.

The distance between tumor and bronchial resection margin (DBTM) had no clear standard in lung cancer surgery. We aimed to select the optimal cut-off value to provide a standard for surgery of the patients with primary endobronchial neoplasm. We retrospectively analyzed patients with primary endobronchial neoplasm who underwent surgical resection between 2005 and 2012. The receiver operating characteristic curves and the Youden index were used to calculate the optimal cut-off value of the DBTM. Propensity score matching was applied to reduce selection bias. Survival was assessed with Kaplan-Meier analysis, log-rank test and Cox proportional hazards model. A total of 1048 patients comprised in the study cohort and 1.7cm was determined the optimal cut-off value, including 531 grouped in DBTM ≤ 1.7cm and 517 grouped in DBTM > 1.7cm. Before propensity score matching, the 5-year recurrence-free survival was 38.7% in DBTM ≤ 1.7cm group and 67.1% in DBTM > 1.7cm (hazard ratio 0.48, P < 0.001), while the 5-year overall survival was 30.1% and 50.7%, respectively (hazard ratio 0.64, P < 0.001). After propensity score matching, the 5-year recurrence-free survival was 38.8%in DBTM ≤ 1.7cm group and66.1% in DBTM > 1.7cm (hazard ratio 0.51, P < 0.001), while the 5-year overall survival was34.7% and50%, respectively (hazard ratio 0.81, P = 0.012). Multivariable cox model showed that the DBTM was an independent predictor for recurrence-free survival (hazard ratio 0.51, P = 0.001) and overall survival (hazard ratio 0.84, P = 0.026). The DBTM was an independent predictor for outcomes in primary endobronchial neoplasm, and patients with the DBTM ≤ 1.7cm should actively receive adjuvant therapy after surgery. The distance between tumor and bronchial resection margin (DBTM), the distance between the most proximal border of the macroscopic tumor and bronchial resection margin was measured by pathologist in the fresh specimens before formalin fixation. The DBTM less than 1.7cm had higher recurrence-free survival and overall survival and was an independent prognostic factor for patients with primary endobronchial neoplasm.

Pulmonary Epithelioid Hemangioendothelioma: A Case Report of Sleeve Resection of this Rare Lung Tumour

Reporting a 37 year old male with pulmonary epithelioid hemangioendothelioma (PEH), whom had undergone a sleeve resection of main left bronchus en bloc with the tumour. Presented with shortness of breath &amp; was treated as pneumonia with left lung collapse. Bronchoscopy showed lesion at left main bronchus &amp; unable to pass the obstruction. CT scan showed left main bronchus endobronchial lesion &amp; histopathological reported it as suspected PEH. Mass had regrown 90% stenosis within 2 weeks. PET scan showed solitary disease at left endobronchial region. Left thoracotomy with sleeve resection of left bronchus en bloc with the tumour done. Intraoperative bronchoscopy showed endobronchial tumour located at the main left bronchus 1cm from carina. Histopathology confirmed the resected lesions are PEH. Patient recovered well. PEH is a histological diagnosis, recent reviews showed that radiological CT findings can be associated. No standard guideline treatment for PEH. There are cases reported with good response to combine chemotherapy and immunotherapy. Unilateral lesions, surgery is indicated. If lesion is positive for oestrogen and progesterone receptors, studies showed that hormonal therapy may benefit. Antivascular endothelial growth factor reported as part of treatment. Prognosis is unpredictable. In view of the rarity of the disease, multi-modulated approach is essential in the management and follow-up of the patient.

Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases.

Since the first uniportal video-assisted thoracoscopic surgery (uVATS) performed in 2010, the uniportal approach has evolved up to a point where even the most complex cases can be done. This is thanks to the experience acquired over the years, the specifically designed instruments and improvements in imaging. However, in these last few years, robotic-assisted thoracoscopic surgery (RATS) has also shown progress and distinct advantages compared to the uniportal VATS approach, thanks to advanced maneuverability of the robotic arms as well as the three-dimensional (3D) view. Excellent surgical outcomes have been reported and so too, the ergonomic benefits to the surgeon. The main limitation we find of the robotic systems is that they are designed for a multiport approach, requiring between three to five incisions to be able to perform surgeries. With the aim to offer the least invasive approach, using the robotic technology we decided to adapt the Da Vinci Xi® in September 2021 to develop the uniportal pure RATS approach (uRATS) performed by a single intercostal incision, without rib spreading and using the robotic staplers. We have now reached a point where we perform all type of procedures, including the more complex sleeve resections. Sleeve lobectomy is now widely accepted as a reliable and safe procedure to allow complete resection of centrally located tumors. Although it is a technically challenging surgical technique, it offers better outcomes when compared to pneumonectomy. The intrinsic characteristics of the robot such as the 3D view and improved maneuverability of instruments make the sleeve resections easier compared to thoracoscopic techniques. As in uVATS vs. multiport VATS, the uRATS approach, due to its geometrical characteristics, requires specific instrumentation, different movements and learning curve compared to multiport RATS. In this article we describe the surgical technique and our initial uniportal pure RATS experience with bronchial, vascular sleeves and carinal resections in 30 patients.

Method of surgical treatment of recurrent pleural empyema with bronchial fistula after right pneumonectomy for destructive drug-resistant pulmonary tuberculosis

Introduction. The treatment of patients with recurrent empyema of the pleural cavity associated with bronchial fistula of the main bronchus has been an urgent problem in phthisiosurgery for many decades. There are non-radi-cal methods of treatment using various variants of bron-cho-obturators and radical methods of treatment, but ac-companied by high trauma due to chest decostation. The authors proposed an original method for the elimination of recurrent bronchial fistula and pleural empyema after right pneumonectomy while preserving the frame of the chest. Materials and methods. A retrospective study for the period from 2016 to 2023 included 9 patients who were operated on for empyema of the pleural cav-ity with a fistula of the right main bronchus according to the original method after previous pneumonecto-my. The duration of the fistula before surgery ranged from 4 to 42 months. Bacterial excretion in sputum was preserved in 3 (33.4%) patients. 8 (88.8%) patients had pre-XDR MTB and only 1 (11.1%) had MDR MTB. In all patients, a mixed (specific and non-specific) flora was determined in the pleural fluid. The surgical strategy was multi-staged. At the first stage, upper-posterior thoracoplasty, thoracotomy, resection of the stump of the right main bronchus, its suturing and myoplasty were performed. At the second stage, an open cleaning of the pleural cavity was performed with tamponage of the residual empyema cavity from the thoracostomy, after that vacuum asssisted closure system was applied to the thoracostomy. At the third stage, myoplastic closure of the thoracostomy was performed. The im-mediate and long-term results of treatment of patients were evaluated. Results. All patients were operated on by the same surgical team. In all cases, resection of the stump of the right main bronchus was performed, for a length of 2 mm to 5 mm. Histological examination of the bronchial resection margin did not reveal tubercu-lous lesions. In the postoperative period, surgical com-plications requiring invasive interventions to eliminate them occurred in 22.2%. In 8 (88.8%) patients, the result of treatment was regarded as satisfactory (persistent absence of fistula, absence of progression of pleural empyema). In a patient with persistent recurrence of the fistula, the result of treatment is regarded as unsat-isfactory. In the long-term period, all patients with satis-factory surgical treatment were removed from the dis-pensary register, data for recurrence of empyema and bronchial fistula were not obtained during the control examination. Against the background of anti-tuberculo-sis chemotherapy, a clinical cure of tuberculosis of the sole lung was achieved with the formation of metatu-berculous fibrotic focal changes without destruction. All patients were persistently abacillated. Conclusion. The proposed multi-stage therapeutic surgical tactics for recurrent empyema of the pleural cavity associated with bronchial fistula of the main bronchus is an optimal alternative to supertraumatic and non-radical methods, since it allows reliable elimination of chronic, often re-current, bronchial fistula with successful treatment of empyema of the residual pleural cavity, and is also ac-companied by low traumatism and the best cosmetic effect while maintaining the frame of the chest wall

Isolated bronchoplastic procedure for typical carcinoid of the left lung

Lung carcinoids (LC) comprise neuroendocrine lung tumors of low (typical carcinoid) and intermediate (atypical carcinoid) grade of malignancy accounting for less than 2% of all lung neoplasms. In Europe, annual incidence of LC varies from 0.2 to 2 per 100 000. This value increased dramatically over the past 30 years. One of the causes is improvement of diagnostic methods. Compared to aggressive high-grade neuroendocrine lung cancer, natural course of early-stage LC is usually indolent. Therefore, surgery with preservation of as much normal lung tissue as possible is preferable for resectable tumors. Nevertheless, the number of isolated bronchial resections with preservation of the entire lung tissue is relatively small, and these procedures remain technically complex interventions. We present isolated resection of interlobular spur, lower medial wall of distal part of the left main bronchus and proximal part of the lower lobular bronchus for typical carcinoid with monobronchial anastomosis and preservation of the entire lung parenchyma.

Endobronchial Inflammatory Myofibroblastic Tumor in a 3-Year-Old Child

AbstractInflammatory myofibroblastic tumor (IMT) is a mesenchymal tumor that can occur at any age. However, it is primarily seen in children, with the most common site being in the lung parenchyma, usually present with rare endobronchial lesions. This case reports the incidence in a 3-year-old girl diagnosed with pericardiac pneumonia treated with antibiotics with no clinical improvement. A chest computed tomography (CT) scan identified a 1.5-cm lesion in the left main bronchus. Bronchoscopy revealed complete obstruction of the left main stem bronchus. A left posterolateral thoracotomy was performed. Additionally, a left sleeve upper bronchial resection was conducted under fibroendoscopic control. Definitive histology confirmed IMT. After 2 years of endoscopic follow-up, there is no evidence of recurrence.

Video-assisted thoracoscopic versus open sleeve lobectomy for non-small cell lung cancer: A systematic review and meta-analysis from six comparative studies.

Lung sleeve resection is indicated for centrally located lung tumors, especially for patients who cannot tolerate pneumonectomy. With video-assisted thoracoscopic surgery (VATS) being increasingly implemented for a wide variety of thoracic pathologies, this study aims to compare the intraoperative, postoperative, and long-term outcomes of VATS and open bronchial sleeve lobectomy for non-small cell lung cancer (NSCLC). The MEDLINE (via PubMed), Cochrane Library, and Scopus databases were searched. Original clinical studies, comparing VATS and open sleeve lobectomy for NSCLC were included. Evidence was synthesized as odds ratios for categorical and weighted mean difference (WMD) for continuous variables. Our analysis included six studies with non-overlapping populations reporting on 655 patients undergoing bronchial sleeve lobectomy for NSCLC (229 VATS and 426 open). VATS sleeve lobectomy was associated with significantly longer operative time ((WMD): 45.85 min, 95% confidence interval (CI): 12.06 to 79.65, p = 0.01) but less intraoperative blood loss ((WMD): -34.57 mL, 95%CI: -58.35 to -10.78, p < 0.001). No significant difference was found between VATS and open bronchial sleeve lobectomy in margin-negative resection rate, number of lymph nodes resected, postoperative outcomes (drainage duration, length of hospital stay, 30-day mortality), postoperative complications (pneumonia, bronchopleural fistula/empyema, prolonged air leakage, chylothorax, pulmonary embolism, and arrhythmia), and long-term outcomes (overall survival, recurrence-free survival). The limitation of our study arises mainly due to the heterogeneity of the included studies. Nevertheless, VATS bronchial sleeve lung resection constitutes a feasible and safe alternative to the open sleeve lung resection surgery for the management of centrally located lung tumors.

EP14.05-018 Major Lung Resection for Carcinoid Tumor; Does It Affect Quality of Life?

Pulmonary carcinoids account for 1% of all lung cancers. Surgery remains the gold standard treatment which may include radical lung resection as well as minimally invasive procedures and parenchymal sparing bronchial resection. However, resection may impact patients' daily activities due to decreased lung reserve and postoperative pain. Our study aims to compare the impact of different types of surgical resection on the post-operative quality of life. To the best of our knowledge this is the first study that measures the change in lung function and quality of life following surgical resection of carcinoid tumors.

Prognostic factors in completely resected lymph-node-negative pulmonary adenocarcinoma.

BackgroundLymph node involvement is one of the important prognostic factors for early-stage lung cancer. However, in lymph node-negative (N0) lung cancer the recurrent rate may be as high as 30%. We aimed to study potential prognostic factors including clinicopathological factors and epidermal growth factor receptor (EGFR) mutation status in this lung cancer population.MethodsWe retrospectively reviewed the medical records and pathological examinations of patients with completely resected N0 pulmonary adenocarcinoma treated in our institute between 2009 and 2016. We used Cobas® test to determine EGFR mutation status. Recurrence-free survival (RFS) was analyzed by univariable and multivariable Cox regression analyses.ResultsWe recruited 220 patients with median duration of follow up 5 years. Majority of these patients were in stage I (80%) and did not receive adjuvant therapy (86%). There were 53% with EGFR mutations which comprised of exon 19 deletion 51% and L858R 43%. Recurrence occurred in 64 out of 220 patients (29%). The median time to recurrence was 2.1 years. Statistically significant prognostic factors in both univariate and multivariate analyses included tumor size ≥4 centimeter (cm) (HR: 1.94; 95% CI: 1.03–3.67), visceral pleural invasion (HR: 2.53; 95% CI: 1.34–4.79), tumor necrosis (HR: 2.45; 95% CI: 1.13–5.31) and bronchial resection margin <2 cm (HR: 1.96; 95% CI: 1.10–3.51). However, presence of sensitizing EGFR mutation was not found to be a significant prognostic factor (HR: 1.20; 95% CI: 0.66–2.18; P=0.56).ConclusionsIn N0 surgically resected lung adenocarcinoma, there were significant pathological prognostic factors including tumor 4 cm or more, visceral pleural invasion, tumor necrosis and bronchial resection margin less than 2 cm. Mutation of EGFR is not a significant prognostic factor to determine the risk of recurrence in this population and their risks shall be determined by the other poor prognostic factors.

Abstract 5781: Molecular positive margin of surgical resections is a strong biomarker for tumor recurrence in pIIIA-N2 NSCLC patients

Abstract Background: The high recurrence rate of stage pIIIA-N2 NSCLC patients may reflect inadequate removal of all residual tumor cells despite conventional histologic negative surgery margin. The NGS-detected BRM status was possible to serve as a more accurate examination to identify those patients with a high-risk of postoperative recurrence. Methods: We retrospectively studied 119 stage IIIA-N2 NSCLC patients who received curative-intent surgery plus adjuvant chemotherapy/chemoradiotherapy, and all of the patients were classified with negative resection margin by the conventional histologic method. Each patient had paired tumor and bronchial resection margin (BRM) samples, which were analyzed using next-generation sequencing (NGS) of 474 cancer-related genes, and we explored the prognostic values of various clinical and molecular features. Results: Among the 119 stage IIIA-N2 NSCLC patients with histologic negative resection margins, the BRM samples from 56 patients (47.1%) were positive for tumor mutations, including multiple lung cancer driver mutations. The number and the variant allele frequency of genetic alterations in BRM samples were generally lower than that of the paired tumor samples. Notably, patients who were positive for NGS-detected BRM mutations had significantly shorter disease-free survival (DFS) than the negative patients (p=0.001, HR 2.18, 95%CI 1.37~3.47). Several other clinical/molecular features were also found to be significantly associated with DFS, including the metastatic lymph node ratio (MLNR), smoking history, and KRAS mutation status, and NGS-assessed BRM status remained to be statistically significant in multivariable analysis by including all of these prognostic factors (p =0.020, HR 1.82, 95%CI 1.10~3.02). Conclusions: We demonstrated that the molecular positive margin of surgical resections was a strong and independent biomarker for disease recurrence in pIIIA-N2 NSCLC patients. Our results emphasized the clinical utility of molecular diagnostic approaches to detect minimal residual disease after surgical resection, which could potentially facilitate the stratification of high-risk patients for personalized and appropriate treatments. Citation Format: Li Li, Kewen He, Jiaohui Pang, Yang Xu, Yang Shao, Shuanghu Yuan, Jinming Yu. Molecular positive margin of surgical resections is a strong biomarker for tumor recurrence in pIIIA-N2 NSCLC patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5781.

Strategy for lung parenchyma-sparing bronchial resection: a case series report.

Lung parenchyma-sparing bronchial resection is uncommon, and the operative procedure depends on the cause and location of the stenosis. We present 6 cases and discuss the different surgical strategies for sleeve resection of the central airway without lung resection. Bronchoplasty for the main bronchus and truncus intermedius was performed with a posterolateral approach. We resected the right main bronchus including the right lateral wall of the lower trachea and half of the carina obliquely and performed an anastomosis. The tumour in the left lobar bronchus was exposed and removed by transient division of the accompanying pulmonary artery. Although post-transplant stenosis and malacia can pose a challenge, bronchoplasty can be used as a definitive treatment in experienced centres.

Intraoperative methods for wrapping anastomoses after airway reconstruction: a case series.

BackgroundAnastomosis management is the main challenge of airway resection and reconstruction, and postoperative anastomotic complications, including ischemia, stenosis, dehiscence, and separation may lead to severe outcomes and a poor prognosis. The anastomotic buttress is vital in airway reconstruction, but the selection of surgical buttress and reinforcement remains controversial. We aimed to demonstrate and evaluate the buttress options of anastomosis, including their preoperative characteristics, the intraoperative process, and the incidence of postoperative complications to help address the controversy regarding anastomosis management.MethodsThis retrospective study was conducted at a single institution. Patients who underwent airway reconstruction with anastomotic wrapping from Jan. 2019 to Sep. 2021 were enrolled in this study and preoperative characteristics and operational features were collected. All patients were carefully followed up by telephone and outpatient. Their postoperative complications and postoperative status after 6 months were recorded. The surgical procedures and clinical characteristics of the buttress options of anastomosis were assessed.ResultsA total of 62 patients undergoing either cervical tracheal, thoracic tracheal, carinal, or secondary carinal and main bronchus resection and reconstruction were evaluated. The anastomotic buttress used included mediastinal pleural flap (24/62, 38.7%), anterior cervical muscle (14/62, 22.6%), sternocleidomastoid (2/62, 3.2%), thymus flap (12/62, 19.4%), intercostal muscle flap (2/62, 3.2%), biological patch (2/62, 3.2%), prepericardial fat (1/62, 1.6%), thyroid gland (1/62, 1.6%), pectoralis major flap (2/62, 3.2%), and omental flap (2/62, 3.2%). All procedures produced satisfactory results without short-term anastomotic complications. A follow-up for 6 months was conducted and all patients were alive postoperatively. Tracheomalacia stenosis postoperatively occurred in 3 patients and they were subsequently treated with an endotracheal stent. One patient had tumor recurrence 3 months after surgery and received adjuvant chemotherapy.ConclusionsVarious anastomotic wrapping materials are used in airway reconstruction. Different utilizations of buttress are selected according to the anatomic characteristics and the reconstruction method used. This study indicated that appropriate surgical buttresses for wrapping anastomoses are legitimate alternatives to reduce the risk of anastomotic complications.

A 3-dimensional airway model for tracheobronchial surgery.

A 3-dimensional airway model for tracheobronchial surgery.

Triple Sleeve Bronchial Resection with Total Lung Preservation.

Triple sleeve bronchial resection with bronchial anastomosis is a complex surgical procedure, more difficult than the standard techniques of bronchial resection and anastomosis, commonly used to treat benign or low-grade malignant neoplasms (such as carcinoid tumours) that are located on the central bronchial axis (primary and lobar bronchi). When performed carefully by a highly trained surgeon, bronchial sleeve resection and reconstruction is a safe and effective surgical procedure. The complete preservation of the lung parenchyma is the main advantage of this surgical technique, along with a radical bronchial tumour resection. Sparing pulmonary function is crucial for both young (to maintain an optimal effort capacity) and elderly patients as well as those with impaired cardiopulmonary function (they may not tolerate lobectomy or pneumonectomy).

Robot-assisted lung-reserved bronchial glomus tumor resection: a case report

Robot-assisted lung-reserved bronchial glomus tumor resection: a case report