Video-Assisted Thoracoscopic Bronchial Sleeve Lobectomy

Bronchial sleeve lobectomy offers a chance to avoid excessive resections such as pneumonectomy in central lung tumors. Recent technical advances enable complex procedures such as video-assisted thoracoscopic bronchial sleeve lobectomy (VABSL). We present a case of a 64-year-old patient who underwent the right upper VABSL due to adenocarcinoma. During resection the bronchus was transsected and a specimen removed due to tumor proximity. Intraoperative frozen section revealed no neoplastic infiltration in the bronchial cut line. Due to a stiff round shape of the bronchial defect, impossible to approximate by direct suturing without kinking, sleeve lobectomy was undertaken. Bronchial section was performed through utility incision partly under direct vision. End-to-end anastomosis was led with open surgery needle holder, forceps and with continuous Maxon 4–0. Postoperative stay was uncomplicated and bronchoscopy revealed wide lumen of anastomosis.