Cardiothoracic Surgery |

Bronchial Pinch Bronchoscopy: A Novel Technique to Resect Carcinoid Tumor of the Bronchus Intermedius FREE TO VIEW

Peter Tsai, MA; Venkata Bandi; Sandeep Markan; Kalpalatha Guntupalli
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Baylor College of Medicine, Houston, TX

Chest. 2014;146(4_MeetingAbstracts):88A. doi:10.1378/chest.1994831
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SESSION TITLE: Cardiothoracic Surgery Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Most carcinoid tumors arisng from bronchus intermedius and growing into the right upper lobe (RUL) orifice tend to end up with a pneumonectomy. Excision of tumor is done by cold blade transecting the bronchus intermedius with avoidance of cutting into tumor. Attempt at serial sampling of the proximal bronchus margin until negative for tumor will allow for saving the RUL, or completion pneumonectomy otherwise. A novel technique is described to bypass the nuance of serial proximal bronchial margin sampling after distal resection, and still allows for definitive salvage of the RUL, avoiding a pneumonectomy.

METHODS: A simultaneous bronchoscopic-assisted pinching method (Bronchial Pinch Bronchoscopy) allows for the surgeon under bronchoscopic guidance, to extrinsically pinch the bronchus intermedius and reduce the usually mobile tumor away from the RUL orifice.

RESULTS: This step allows for the tumor, if it is mobile, to be safely reduced back into the bronchus intermedius, allowing for a stapling device to be applied proximal to the extrinsic pinch, guaranteeing a negative margin and salvage of the RUL instead of a pneumonectomy.

CONCLUSIONS: In the common situation where the carcinoid tumor is originating from the bronchus intermedius and "growing" pass the RUL orifice, traditional operative techniques by the thoracic surgeon involves intraoperative cut down of the juncture of RUL and bronchus intermedius, with risks of cutting into tumor. The mess and imprecision would lead to sampling of the proximal margin for tumor presence, and more than likley result in a pneumonectomy. This novel technique of combined endoscopic bronchoscopy with extrinsic pinching of the bronchus intermedius--Bronchial Pinch Bronchoscopy, will allow a mobile carcinoid to be reduced distally away from the RUL orifice and with confidence, fire a stapling device proximal to the extrinsic pinch, increasing the chance of a negative margin and ultimately saving the RUL, and the patient from a pneumonectomy.

CLINICAL IMPLICATIONS: The novel technique of Bronchial Pinch Bronchoscopy can be applied for mobile carcinoid tumors in main bronchus with simultaneous endoscopic confirmation of successful reduction of tumor distally. This can potentially increase the ease of a successfully stapled proximal bronchial margin negative of tumor, and in special circumstances like this, avoidance of a pneumonectomy.

DISCLOSURE: The following authors have nothing to disclose: Peter Tsai, Venkata Bandi, Sandeep Markan, Kalpalatha Guntupalli

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