Naoko Yoshii

A new approach to left sleeve pneumonectomy: complete VATS left pneumonectomy followed by right thoracotomy for carinal resection and reconstruction

BackgroundLeft sleeve pneumonectomy is a challenging operation that requires individualized approaches. Here, we present a new minimally invasive combined thoracoscopic approach.Case presentationA 61-year-old woman was diagnosed with tracheobronchial adenoid cystic carcinoma. The tumor originated from the left main stem bronchus, and tumor with carinal involvement was observed. We judged that complete resection would be possible via left sleeve pneumonectomy. However, because tumor involvement with the esophagus and descending aorta was suspected, evaluation of resectability in advance was necessary. After confirmation via examination thoracoscopy of no involvement with the surrounding organs, complete VATS left pneumonectomy was performed and followed by right thoracotomy for carinal resection and reconstruction.ConclusionsWhen thoracoscopic surgery becomes mainstream, this minimally invasive combined thoracoscopic approach might be an optimal option for patients who require left sleeve pneumonectomy.

Bronchoscopic Balloon Dilation (BBD) for Benign Tracheobronchial Stenosis

Bronchoscopic balloon dilation (BBD) is a useful method of treating tracheobronchial stenosis. Tracheobronchial stenosis in adults can arise from benign or malignant disease. Benign stenosis causes include sarcoidosis, tuberculosis, Wegener’s granulomatosis, trauma, berylliosis, and foreign body reaction. Furthermore, it can arise after prolonged endotracheal intubation, after sleeve resection or after lung transplantation. Despite adequate systemic therapy, airway stenosis may progress due to tuberculosis or sarcoidosis. In infants, prior use of endobronchial and tracheostomy tubes or congenital stenosis from complete cartilaginous rings are the primary reasons for such stenosis (McDonald & Stocks, 1965; Parkin ea al., 1976). Subglottic or tracheal sites are thus common and may continue to present serious and often fatal respiratory problems in infants. In adults, the etiologies are variable and the stricture can happen in any part of the airway. Tracheobronchial stenosis may produce symptoms such as dyspnea, cough, wheeze, stridor, or recurrent lower respiratory tract infections, and these symptoms cause the airway stricture to mimic asthma. There are various treatments including surgical resection, laser resection, and bougie dilation during rigid bronchoscopy. For lesions causing impending respiratory failure, surgical resection or stent placement is the most prudent treatment. In less urgent conditions, BBD has been considered a simple, rapid, and safe method to restore airway caliber. BBD has been used alone or in combination with other modalities such as laser resection, cryotherapy, and electrocautery. In 1984, Cohen et al. (Cohen et al., 1984) reported a successful balloon dilation through a tracheostomy tube under propylidone injection for a stricture after segmental resection of congenital stenosis in an infant. In 1987, Fowler et al. (Fowler et al., 1987) described bronchoscopic balloon dilation using a rigid bronchoscope for anastomotic stenosis in an adult who had had a sleeve resection for an endobronchial squamous cell carcinoma of the right main-stem bronchus 2 years earlier. The following year Carlin et al. (Carlin et al., 1988) reported two cases of bronchial stenosis successfully treated with a combination of bronchoscopic balloon dilation and Nd-YAG laser photoresection with a rigid bronchoscope. In 1991, balloon dilation using flexible bronchoscopy was described for the first time by Nakamura et al. (Nakamura et al., 1991). They treated two patients with tuberculous bronchial stenosis through a flexible bronchoscope under local anesthesia. Since then, several reports of BBD have been published (Ball et al., 1991; Keller &