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Iatrogenic Left Mainstem Bronchus Injury And Repair During Right Sided Lung Resection
Adin Reisner, Matthew Inra.
Northwell Lenox Hill Hospital, New York, NY, USA.
BACKGROUND: We present a case of a left mainstem bronchus intubation injury that occurred during a right thoracoscopic robotic-assisted wedge resection.
METHODS: A surgical video is presented and discussed to demonstrate the surgical and anesthetic principles and approach to manage this complication safely in a minimally invasive fashion.
RESULTS: The injury was recognized intraoperatively and the extent of the injury was assessed. There was a linear laceration of the posterior membrane of the left mainstem bronchus. A primary repair with autologous tissue flap buttress was the plan for repair. In collaboration with anesthesia, appropriate ventilation techniques were used to ventilate the patient during repair. Ultimately, the injury was primarily closed in a running fashion and buttressed with a pedicle intercostal muscle flap under jet ventilation. The patient was extubated in the operating room and had an uneventful hospital stay.
CONCLUSIONS: The left mainstem bronchus is easily accessible from the right hemithorax. Assessment of the extent of injury and primary repair with autologous tissue flaps are safe and durable for repair. From the right hemithorax, communication with anesthesia is essential to ventilate the patient safely and effectively. There are many ways to ventilate the patient in this situation and the appropriate method should be determined on a case by case basis.
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