Airway Management of the Right Anterior Segmentectomy through Uniportal Video-Assisted Thoracoscopic Surgery (VATS) after Left Pneumonectomy by An Adapted Double-lumen Endobronchial Tube (DLT): A Case Report

Abstract

Background Lung resection after previous contralateral pneumonectomy is rare. We present a case of right anterior segmentectomy despite previous left pneumonectomy, demanding special ventilation strategy. Case presentation A 48-year-old woman was going to have the right anterior segmentectomy through uniportal video-assisted thoracoscopy (VATS) who had left pneumonectomy two years ago. A 32-French left-sided double-lumen endobronchial tube (DLT) was chosen and adapted. The DLT was intubated into the bronchus intermedius. And the upper lobe can be isolated from the ventilation in the middle and lower lobes when the bronchial cuff’s inflated. The perioperative period was uneventful and the pathological diagnosis was adenocarcinoma. Conclusion Lung cancer radical resection was discouraged after previous contralateral pneumonectomy partly due to the challenging ventilation and isolation. With this new DLT adapting and intubation technique showed in this case, the challenging ventilation and isolation that deter the promotion of the operation could be solved.