A bronchopleural fistula (BPF) may be one of the most disappointing complications of pneumonectomy or lobectomy. The clinical sequela may include incomplete lung expansion, empyema, prolonged ventilator support, and often gas exchange problems in addition to increased morbidity and mortality. Numerous modalities using chemical agents and mechanical devices have been reported for fistula closure.
A 72-year-old female underwent left upper lobectomy for squamous cell carcinoma. Following prolonged air leak, a flexible fiberoptic bronchoscopy was performed which revealed the presence of a 4mm dehiscence in the bronchial closure representing a bronchopleural fistula. Upon repeat bronchoscopy, FocalSeal-L®, a synthetic absorbable sealant, was instilled under direct visualization through a bronchoscope, and activated using a helium cadmium laser.DISCUSSION: FocalSeal-L®, a water-soluble polyethylene glycol-based gel, comes as a polymer and sealant activated by a xenon-generated light wand. The wand provides light in the spectrum of 440nm to 550nm. Intra-operatively, the wand is to be held for 45 seconds about 2cm from the area in which the sealant and polymer has been applied. Crosslinking of the compounds then occurs. Currently FocalSeal-L® has an indication for the use as adjunct to standard closure of visceral pleural air leaks incurred during elective pulmonary resection. The LIFE system, which is used for autofluorescence bronchoscopy, emits blue light from a helium cadmium laser at a wavelength of 442 nm with 150mW of output. Therefore we used this system as our light source to bronchoscopically photoinitiate activation of the compound
We believe this is the first report of the use of bronchoscopically delivered FocalSeal-L® in conjunction with LIFE light activation for the repair of a bronchopleural fistula. This technique may provide physicians treating patients with BPFs another non-surgical approach.
Image 1. 4mm bronchopleural fistula
Image 2. BPF following instillation of polymer and sealant
Image 3. Helium cadmium laser light source applied (442 nm wavelength) to photoinitiate activation
Image 4. BPF following activation
D.S. Hoffberger, None.