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Akinori Iwasaki

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    EP1.01 - Advanced NSCLC (ID 150)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-101 - Transposition of the Pulmonary Veins for Mobilization of Rt-Middle and Lower Lobes for Safe Reconstruction After Carinal Rt-Upper Lobectomy (Now Available) (ID 1320)

      08:00 - 18:00  |  Author(s): Akinori Iwasaki

      • Abstract
      • Slides


      A variety of techniques for reconstruction of the carina after carnal or carinal right upper lobe resection have been proposed. The most important point to accomplish this complex surgery is to achieve safe tension free airway anastomosis. Here we report a case of carinal right upper lobectomy, in whom transposition of the middle and lower pulmonary veins to the opening of the right superior pulmonary vein was performed to achieve safe tension free anastomosis between the trachea and right intermediate bronchus (RIB).


      A 70-year-old female was admitted with severe cough. Bronchoscopy and CT scan revealed an intraluminal tumor obstructing the right main bronchus. A biopsy returned a diagnosis of adenoid cystic carcinoma. After tumor debulking by rigid-bronchoscope, extension of the tumor to the RIB and left main bronchus (LMB) was clarified and it was judged that complete resection of the lesion is possible by carinal right upper lobectomy.


      A standard posterolateral thoracotomy was performed. Firstly, the trachea and LMB were transected at 2 cartilage rings above and below the carina respectively, and end-to-end anastomosis was safely performed. Then the RIB was transected immediately after the tumor invasion and the carinal right upper lobectomy was completed. Because the patient's LMB was narrow, side-to-end anastomosis of the RIB to the lateral wall of LMB was considered to be at high-risk for anastomotic stenosis. Thus the most desirable reconstruction procedure of the RIB was thought to be the side-to-end anastomosis to the lateral wall of the trachea. However, the opening of the RIB was far apart from the desirable anastomosis point of the trachea despite mobilization procedures such as right hilar release. The right middle and lower pulmonary veins were thus resected and transferred to the opening of the superior pulmonary vein and anastomosed by the double-barrel fashion. The opening of the RIB was then elevated and implanted to the lateral wall of the trachea. プレゼンテーション1.png


      The technique of pulmonary venous transposition can be an excellent airway release maneuvers to achieve safe tension free anastomosis between trachea and RIB in case of carinal right upper lobectomy.

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