Left sleeve pneumonectomy via a clamshell incision for lung cancer with carinal invasion: report of a case

Abstract

Surgery for lung cancer involving the carina has been a challenge due to surgical technique and airway management. A case that was successfully treated with left sleeve pneumonectomy performed through a clamshell incision (bilateral thoracotomy through a transverse sternotomy) for carinal invasion of primary lung cancer, is reported.Without a cardiopulmonary assist device, adequate ventilation and oxygenation were maintained across the operative field with a spinal tube. Tracheo-bronchial anastomosis was relatively easy to perform with the excellent surgical view. The patients' postoperative course was uneventful, and chest CT showed no complications at the anastomosis. The patient was discharged without oxygen support. There has been no evidence of recurrence during 6 months of follow-up.A clamshell incision approach provided an excellent surgical view without changing the position of the patient during the operation and could be a useful procedure for carinal surgery, especially for left sleeve pneumonectomy.

Left carinal pneumonectomy using left bronchostomy: A novel technique of crossfield intubation

“…The clamshell incision approach is known to provide excellent surgical exposure and is reported to have been used for left carinal pneumonectomy. 4 Crossfield ventilation via bronchostomy is capable of maintaining stable oxygenation and ventilation, and it facilitates the smooth performance of tracheobronchial anastomosis because the lung that is being ventilated is not involved in the reconstruction after the limits of resection have been defined. The application of extracorporeal lung support (ECLS) including cardiopulmonary bypass and extracorporeal membrane oxygenation may be effective for avoiding cross-field ventilation 5 ; however, ECLS likely will increase the amount of bleeding during surgery because of the anticoagulation during ECLS, especially in cases with severe adhesion.…”

Single-stage bilateral thoracic surgery via a combined VATS and open approach for left central bronchogenic carcinoma with carinal invasion: report of two cases

“…Therefore, right thoracotomy is commonly added to left sleeve pneumonectomy [ 4 , 5 ], but such one stage bilateral thoracotomy is associated with severe surgical trauma, loss of pulmonary function, postoperative respiratory failure, and high mortality rates [ 3 ]. Bilateral thoracotomy through a transverse sternotomy via a clamshell incision has been reported as an alternative surgical approach for carinal and airway reconstruction surgery [ 6 ]. However, this approach has some disadvantages, such as severe surgical trauma and the lack of upper mediastinal lymph node dissection.…”

Bilateral Anterior Thoracotomy (Clamshell Incision) Is the Ideal Emergency Thoracotomy Incision: An Anatomical Study: Reply

“…1d,e) the superiority of the clamshell incision to gain access to the posterior mediastinum (lung roots, descending aorta, azygos vein, esophagus) and to gain access to the structures of the superior mediastinum that lie behind the plane of the trachea (including the trachea itself, left subclavian artery, and esophagus). The clamshell incision is the preferred route for cardiovascular and thoracic surgeons who want to gain access to these structures in especially difficult circumstances [3][4][5]. So, indeed, there is no comparison between median sternotomy and clamshell incision.…”