Hiroaki Osada, MD, Koji Kojima, MD The Annals of Thoracic Surgery

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Presentation transcript:

Experimental tracheal reconstruction with a rotated right stem bronchus Hiroaki Osada, MD, Koji Kojima, MD The Annals of Thoracic Surgery Volume 70, Issue 6, Pages 1886-1890 (December 2000) DOI: 10.1016/S0003-4975(00)01847-6

Fig 1 (A) Lobes of the right lung other than the apical lobe were resected. However, the bronchi of the diaphragmatic and intermedius lobes were left in place and then manipulated to create an extension of the right stem bronchus to form a single conduit by cutting the lobar bronchi longitudinally and then suturing. A pair of vascular clamps was applied to the right stem bronchus to prevent air leakage during the procedure. The apical lobe bronchus was then severed, and the proximal end was closed with sutures. (B) A segment of the mediastinal trachea 10 cartilage rings in length was resected, and the distal end was closed with an autostapler. Another endotracheal tube was inserted retrogradely through the right stem bronchus to ventilate the left lung. Subsequently, the entire right stem bronchus was rotated (arrow) in the frontal plane with the main carina as the center of rotation. (C) The original distal end of the extended right stem bronchus was anastomosed end-to-end to the proximal end of the trachea. A hole was then made in the lateral wall of the rotated stem bronchus, to which the right apical lobe bronchus was anastomosed. The Annals of Thoracic Surgery 2000 70, 1886-1890DOI: (10.1016/S0003-4975(00)01847-6)

Fig 1 (A) Lobes of the right lung other than the apical lobe were resected. However, the bronchi of the diaphragmatic and intermedius lobes were left in place and then manipulated to create an extension of the right stem bronchus to form a single conduit by cutting the lobar bronchi longitudinally and then suturing. A pair of vascular clamps was applied to the right stem bronchus to prevent air leakage during the procedure. The apical lobe bronchus was then severed, and the proximal end was closed with sutures. (B) A segment of the mediastinal trachea 10 cartilage rings in length was resected, and the distal end was closed with an autostapler. Another endotracheal tube was inserted retrogradely through the right stem bronchus to ventilate the left lung. Subsequently, the entire right stem bronchus was rotated (arrow) in the frontal plane with the main carina as the center of rotation. (C) The original distal end of the extended right stem bronchus was anastomosed end-to-end to the proximal end of the trachea. A hole was then made in the lateral wall of the rotated stem bronchus, to which the right apical lobe bronchus was anastomosed. The Annals of Thoracic Surgery 2000 70, 1886-1890DOI: (10.1016/S0003-4975(00)01847-6)

Fig 2 (Dog 4.) Plain chest x-ray film shows the well-patent right apical lobe 3 months after operation. The Annals of Thoracic Surgery 2000 70, 1886-1890DOI: (10.1016/S0003-4975(00)01847-6)

Fig 3 (Dog 5.) Bronchoscopic views obtained 1 year after operation. (Right) Smooth mucosa at the site of anastomosis of the rotated right stem bronchus to the original trachea. (Left) Well-healed and well-patent anastomosis of the right apical lobe (to the right) and the left main bronchus (to the left) beyond the original main carina. The Annals of Thoracic Surgery 2000 70, 1886-1890DOI: (10.1016/S0003-4975(00)01847-6)

The Annals of Thoracic Surgery 2000 70, 1886-1890DOI: (10 The Annals of Thoracic Surgery 2000 70, 1886-1890DOI: (10.1016/S0003-4975(00)01847-6)