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Fig 12.12. Right upper lobectomy and sleeve resection of adjacent main-stem bronchus. (a) Ligation of azygous vein and right upper pulmonary artery and vein branches. (b) Proposed sleeve resection. (c) Right upper lobe has been resected. A bronchoplasty between the right mainstem bronchus and the bronchus intermedius will be done. Reprinted with permission from Shields TW. Bronchial Sleeve Lobectomy. In: Shields TW. 3rd ed. General Thoracic Surgery; p. 379. © Williams & Wilkins.

tion. The inferior pulmonary ligament is taken. The hilum is mobilized and the right upper lobe branch of the right superior pulmonary vein is taken. Then either anteriorly or within the fissure, the right superior pulmonary artery (truncus anterior) is taken and the posterior ascending artery is separately taken within the fissure. Posteriorly, the take-off of the right upper lobe bronchus from the right main bronchus is identified. The right mainstem is transected medially, the bron-

chus intermedius is transected proximally, and the right upper lobe is removed en bloc. The bronchus intermedius is then anastomosed to the right mainstem bronchus with interrupted 3-0 Vicryl. A pleural or pericardial flap is placed over the bronchoplasty to increase vascularity and provide support in the event of a leak.

Postoperative pulmonary care must be meticulous and bronchoscopy is warranted immediately with any evidence of right middle or lower lobe collapse or infiltrate.

Suggested Reading

1. Bains MS. Surgical treatment of lung cancer. Chest 1991; 100:826-837.

2. Aisner J, Alberto P, Bitran J et al. Role of chemotherapy in small cell lung cancer: A consensus report of the International Association for the study of lung cancer workshop. Cancer Treat Ref 1983; 67:37-43.

3. Meyer JA. Five year survival in treated stage I and II small cell carcinoma of the lung. Ann Thorac Surg 1986; 42:668-669.

4. Pearson FG, Nelems JM, Henderson RD et al. The role of mediastinoscopy in the selection of treatment for bronchial carcinoma with involvement of superior mediastinal lymph nodes. J Thorac Cardiovasc Surg 1972; 64:382-390.

5. Pancoast HK. Superior pulmonary sulcus tumor: tumor characterized by pain, Horner's syndrome, destruction of bone and atrophy of hand muscles. JAMA 1932; 99:1391-1396.

6. Paulson DL. Superior sulcus carcinomas. In: Sabiston DC Jr, Spencer FC eds. Gibbon's surgery of the chest; 4th ed. Philadelphia: WB Saunders, 1983:506.

7. Grillo HC, Zannini P, Mickelassi F. Complications of tracheal reconstruction: incidence, treatment, and prevention. J Thorac Cardiovasc Surg 1986; 91:322-328.

8. Wilkins EW Jr. The asymptomatic isolated pulmonary nodule. N Engl J Med 1955; 52:515-520.9. Mountain CF. Revisioons in the international system for staging lung cancer. Chest 1997; 111:1710.

10. Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997; 111:1718.

11. McCaughan BC et al. Chest wall invasion in carcinoma of the lung: therapeutic and prognostic implications. J Thorac Cardiovasc Surg 1985; 89:836.

12. Mansour KA, Wanna FS. Extended resection of bronchial carcinoma in the superior pulmonary sulcus. In: Shields TW, LoCicero J III< Ponn RB (eds). Lippincott Williams & Wilkins, Philadelphia, 2000; 467-72.

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