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Indications

• Locally advanced tumour entering bronchial tree

Relative risks

• Death 1-2%
• Atrial fibrillation
• Thromboembolism
• Bleeding
• Infection
• Persistent air leak

Procedure

1. Pre-operative bronchoscopy: check lesion position
2. Postero-lateral thoracotomy
3. Chest opened through 5th ICS
4. Harvest intercostal muscle bundle (to protect anastomosis)
5. Check pleural cavity for deposits, effusion, completeness of fissures
6. Pulmonary ligament diveided up to inferior pulmonary vein (allows identification of IPV and also allows lung to move up when re-expanding)
7. Anterior and superior hilum dissected to expose superior pulmonary vein and main pulmonary artery with proximal branches
8. Staple pulmonary vein
9. Limited clearance of adventitia from proximal left main bronchus and upper lobe bronchus
10. Bronchus divided distally to upper lobe bronchus
11. Inspect margin
12. 2/0 prolene stay sutures through proximal and disal bronchial stumps at junction of cartilaginous and membranous parts
13. Bronchial anastomosis fashioned under aortic archwith continous 4/0 PDS to membranous bronchus, interrupted 4/0 prolene to cartilage with telescoping od smalled distal bronchus to main stem
14. Intercostal bundle interposed between PA and bronchial anastomosis and wrapped around
15. Lymph nodes sampled
16. Washout with warm water to check for air leak
17. Post-op bronchoscopy checking anastomosis with patency

Post op

• Chest X-ray
• Chest drains on suction 3-5kPa