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Right arrow Trachea and bronchi

J Thorac Cardiovasc Surg 2002;124:632-635
© 2002 The American Association for Thoracic Surgery

Brief Communications

Simplified anastomotic technique for end-to-side bronchial reimplantation onto the trachea or contralateral main bronchus after complex tracheobronchial resections

Gaetano Di Rienzo, MD, Tetsuhiko Go, MD, Paolo Macchiarini, MD, PhD Hannover, Germany

From the Department of Thoracic and Vascular Surgery, Heidehaus Hospital (Hannover Medical School), Hannover, Germany.

Received for publication Jan 4, 2002. Accepted for publication Feb 14, 2002. Address for reprints: Paolo Macchiarini, MD, PhD, Department of Thoracic and Vascular Surgery, Heidehaus Hospital (Hannover Medical School), Am Leineufer 70, 30419 Hannover, Germany (E-mail: pmacchiarini@compuserve.com).

The first 20% of the full text of this article appears below.

Recent anesthetic and surgical advances have remarkably reduced the frequency of airway complications after tracheobronchial resections, yet the end-to-side reimplantation of a main, lobar, or intermedius bronchus onto the trachea or the side of the contralateral main bronchus still represents a major technical challenge with high anastomotic morbidity and procedure-related mortality.Go 1 We present the results of a simplified anastomotic technique for end-to-side reimplantation of the lobar or intermedius bronchus onto the trachea or contralateral main bronchus after extensive bronchial sleeve resections or carinal lobectomy.

Clinical summary

Since April 1999, 10 patients underwent an elective tracheobronchial resection with 6 different types of end-to-side secondary anastomoses for benign (Table 1) or malignant (Table 2) processes. All patients received total intravenous anesthesia with a process electroencephalogram and were intubated through a double-lumen endobronchial tube, and the intraoperative intermittent cross-field ventilation concept was used.Go 2 Right-sided tumors were approached through an ipsilateral muscle-sparing posterolateral thoracotomy in the fifth intercostal space, and left-sided tumors were managed with a midline transsternal approach. All patients with cancer had a complete nodal dissection. The basic surgical principles of carinal resection and end-to-end primary anastomosis outlined by GrilloGo 3 and usGo Go 2,4 were followed.


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  		Table 1. Profile of patients with benign lesions undergoing sleeve main stem and intermedius bronchi resection and tracheal reimplantation of the right upper lobe bronchus
 

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  		Table 2. Tracheobronchial reconstructions for non–small cell lung cancer
 
There are, however, peculiarities of the bronchial end-to-side secondary reimplantation. First, the opening on the receiving trachea or bronchus should be large enough (at least 1 to 1.5 cm2) to host the implanting bronchus and within the first 1 . . . [Full Text of this Article]




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[Abstract] [Full Text] [PDF]


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