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Case reports

Video-mediastinoscopic resection of a long bronchial stump and reclosure of bronchial insufficiency after pneumonectomy

Department of Thoracic Surgery, ELK Berlin Chest Hospital, Lindenberger Weg 27, D-13125 Berlin, Germany

Received 18 December 2008; received in revised form 3 February 2009; accepted 4 February 2009.

^_* Corresponding author. Tel.: +49 30 94802 100; fax: +49 30 94802 180. (Email: gunda.leschber{at}elk-berlin.de).

Bronchial stump insufficiency after pneumonectomy is a severe problem and there is still debate about the appropriate method (transthoracic or transsternal) for reclosure. Access through a sterile operative field for a successful redo-procedure seems to be important so an alternative to the open methods could be the video-mediastinoscopy as it allows approaching the bronchial stump via the mediastinum. Previously in 1996 Azorin performed the first mediastinoscopic reclosure by stapling an early insufficiency after left pneumonectomy. We report the first case to our knowledge of resection and reclosure in bronchial stump insufficiency via mediastinoscopy. An HIV-positive man presented with late bronchial stump insufficiency after left pneumonectomy for lung cancer. The cause was a long bronchial stump and there was no sign of tumour recurrence. Decision was made for a video-mediastinoscopy and resection and reclosure successfully performed by using an endostapler device. Postoperative bronchoscopy at six months revealed a well-healed stump and two years postoperatively the patient is doing well. The mediastinoscopic approach is a novel option in highly selected patients. It warrants minimal surgical trauma; however, one has to be prepared to convert to an open technique immediately.

Key Words: Bronchial stump insufficiency • Pneumonectomy • Mediastinoscopy • Minimal invasive surgery • Endoscopic procedure • Reoperation