V-050EXTENDED DOUBLE SLEEVE RIGHT UPPER LOBECTOMY (SO-CALLED TYPE A EXTENDED SLEEVE) COMBINED WITH TRANSPOSITION OF THE INFERIOR PULMONARY VEIN FOR LUNG CANCER

Objectives: Bronchovascular sleeve is one of the established techniques to avoid pneumonectomy. Right upper extended sleeve, i.e. resection of the upper, middle lobe and segment 6 of the lower lobe, may lead to kinking the inferior pulmonary vein resulting in impaired venous return postoperatively. We present a case of extended sleeve resection combined with transposition of the inferior pulmonary vein to prevent kinking of the inferior pulmonary vein. Video description: A 67-year-old man, 175 cm in height and 117 kg in weight, with a past history of subarachnoid haemorrhage had squamous cell carcinoma of the lung in the right hilum. This lung cancer invaded the interlobar pulmonary artery and the bronchus, and was resectable by pneumonectomy. However, the patient could not tolerate pneumonectomy, and we decided to perform extended sleeve resection. A posterolateral incision was used for resection. Systematic lymph node dissection was performed first to confirm resectability. Dissection of lower bronchus was performed and the intersegmental plane between segment 6 and basal segment was dissected. The right main bronchus was cut and the superior and middle pulmonary vein was also cut as well as the vein of segment 6. To anastomose between the right main bronchus and the basal bronchus, tension between these bronchi is too tight and kink of the inferior pulmonary vein was confirmed intraoperatively. Thus, we performed transposition of the inferior pulmonary vein to the orifice of the superior vein, followed by bronchoplasty and arterioplasty. Lung cancer was finally completely resected and operative time was 334 min with blood loss of 305 cc. Technical pitfalls are discussed. Postoperative course was uneventful except pneumonia. The patient was discharged on the 17th postoperative day. Conclusions: Transposition of the inferior pulmonary vein was effective for extended right upper, middle, and segment 6 double sleeve resection for lung cancer. Disclosure: No significant relationships.