DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right upper lobe non-small cell lung cancer.
POSTOPERATIVE DIAGNOSIS: Right upper lobe non-small cell lung cancer.
PROCEDURES PERFORMED:
1. Right upper lobe sleeve lobectomy.
2. Pericardial fat pad flap.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
INDICATIONS FOR OPERATION: The patient is a man with a right upper lobe mass diagnosed as carcinoma at the orifice of the right upper lobe bronchus, which would make standard right upper lobe lobectomy inadequate to achieve negative margin. A pneumonectomy could be performed as necessary; however, it was felt that a sleeve lobectomy would be ideal in offering an ideal oncologic operation while preserving pulmonary parenchyma.
DESCRIPTION OF OPERATION: A thoracotomy was performed. The right upper lobe pulmonary vein was divided as was the truncus branch of the pulmonary artery to the right upper lobe. The bronchus intermedius and right main bronchus were then encircled. The right upper lobe bronchus was looped.
At this point, we performed bronchoscopy while inserting a needle into the right main bronchus and identified the location just proximal to the tumor that would provide a negative margin. We performed a similar procedure in the bronchus intermedius distal to the tumor. This, therefore, identified the proximal and negative resection lines. The right main bronchus was then divided, carefully dissecting it off of the main pulmonary artery. The bronchus intermedius was then dissected and a specimen was handed off. Frozen section analysis of the separately submitted proximal main bronchial margin showed no evidence of tumor.
After verifying the absence of tension, we then placed 2-0 Vicryl stay sutures at 3 o’clock and 9 o’clock on the main bronchus in the bronchus intermedius. When these were held together, the ends came together without tension. We then performed an end-to-end anastomosis in a standard fashion. Interrupted 4-0 Vicryl sutures were placed circumferentially. We then tied the stay sutures together to relieve tension, and the 4-0 Vicryls were sequentially tied together.
A pericardial fat pad flap was then mobilized, and this was placed circumferentially around the anastomosis and fixed in place with fine sutures. Before tying this down, we had tested the bronchial anastomosis to a maximum of 30 cm of water pressure without any evidence of leak. A 28-French chest tube was inserted, and the thoracotomy was closed after reinflating the lung.
The patient was extubated and brought to the postanesthesia care unit hemodynamically stable and breathing spontaneously. There were no intraoperative complications.
