Techniques of Bronchial Sleeve Resection

Abstract

A bronchial sleeve resection can be considered for lesions arising from a lobar bronchus so as to preclude a standard lobectomy, yet without enough distal involvement as to warrant a pneumonectomy. Limited bronchial resection allows maximal conservation of pulmonary function in patients with benign or malignant disease, without compromising oncologic outcome. This article defines the indications and preoperative management of candidate patients and discusses key anesthetic considerations and surgical techniques for this complex airway reconstruction. The essential component of a successful operation is a tension-free bronchial anastomosis. Open communication and careful discussion of airway management between anesthesiologist and surgeon will help ensure a good outcome.

Extended Sleeve Lobectomy: One More Step Toward Avoiding Pneumonectomy in Centrally Located Lung Cancer

“…To be reliable, ESL should be associated with R0 resection [21] and requires frozen section analysis of bronchial stumps. Okada and colleagues [6] chose resection points with a margin of at least 1 cm of macroscopically unaffected bronchus.…”

Anesthesia for Tracheobronchial Surgery

“…The surgical approach to sleeve resections is discussed in detail in an accompanying article by Yu and Weyant. 26 If an open approach is planned, a thoracic epidural should be offered to help control postoperative pain. If the procedure is to be done by video-assisted thoracoscopic surgery, one could consider paravertebral blocks.…”

The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary center

“…The potential reason might be the technical difficulties of this complex procedure. 11 In addition, insufficient surgical expertise may obscure the inherent benefits of the thoracoscopic approach. 12 , 13 , 14 To achieve proficiency, where robust oncologic tenets and the greatest safety parameters are guaranteed, it is necessary to complete an apprenticeship period.…”