Uniportal VATS Sleeve Resection of the Bronchus Intermedius

This video presents a case of a typical carcinoid tumor located in the distal part of bronchus intermedius. The patient is a fifty-six-year-old woman who is a nonsmoker. Her comorbidities included bronchial asthma, obesity, type 2 diabetes, and arterial hypertension. After a few weeks of wheezing and coughing, a chest CT scan was performed and the patient was referred for bronchoscopy, which revealed endoluminal lesion in the bronchus intermedius. A biopsy confirmed the diagnosis of typical carcinoid. 

The patient’s pulmonary function was good, and since middle lobe bronchus seemed to be uninvolved, the surgical team decided to perform a parenchyma-sparing sleeve resection of the bronchus intermedius. However, the possibility of bronchial sleeve middle lobectomy was also discussed in case of middle lobe bronchus infiltration by the tumor. 

The patient had no air leak after surgery, and the chest tube was removed on postoperative day three. Her postoperative course was complicated with right lower lobe pneumonia, which resolved with antibiotics. Final pathology reported R0 resection and a diagnosis of pT1aN0 typical carcinoid. Since anastomosis was very challenging, the patient was asked to undergo an early follow-up. There were no signs of bronchial stenosis or recurrence on a CT scan or bronchoscopy three months after operation.