1. Sleeve and wedge parenchyma-sparing bronchiaresections in low-grade neoplasms of the bronchial airway J Thorac Cardiov asc Surg 2007;134:373-7

2. Objective Objective A retrospective studies A retrospective studies represent a surgical option in selected cases of low-grade neoplasms of the airway. Analyze the indications, the operative technique, and the results of such operations.

4. Methods Methods From 1980 to 2006, 248 bronchoplastic procedures was performed ( 26 of those were bronchoplastic procedures without parenchymal resection for low grade neoplasms of the airway) 17 men and 9 women with a mean age of 49.4 years (range 19-74 years).

5. Methods Methods A preoperative workup including a physical examination, a chest radiograph and computed tomographic (CT) scan, an abdominal ultrasound, and a bronchoscopic examination with biopsy. intraoperative bronchoscopic examination CT with 3-dimensional reconstruction (virtual endoscopy) preoperative laser treatment

8. Operative methods Operative methods Wedge bronchial resections were sutured with single stitches of polyglyconate 4-0 (Maxon) Sleeve bronchial resections were performed with a continuous suture in the membranou wall and single stitches in the cartilagineous part. Suture sites was wrapped with either pedicled pericardial fat or pleura or fibrin glue to prevent a bronchovascular fistula. Dissect the inferior pulmonary ligament Fill the pleural cavity with saline solution, reexpaned the lung – check air leakage

9. Operative methods Operative methods Remove hilar and peribronchial lymph nodes, and a systematic sampling of the mediastinal nodes was performed. Post-operation : chest CT and a bronchoscopic examination were performed every 6 months for the first 2 years and then on an annual basis.

10. Results Results The resection margins were always tumor free. There was no operative mortality. The mean hospital stay was 6.7 days (range 4–16 days). One minimal dehiscence and no stenosis of the anastomosis were observed. In 1 case, a granulation that required an endoscopic treatment.

11. Results – site of bronchoplaties

12. Results Results Histologic type : carcinoid (n 18), mucoepidermoid (n 2), adenoid cystic (n 1), chondroma (n 2), hamartoma (n 1), melanoma endobronchial metastasis (n 1), and glomic tumor (n 1).

13. Conclusions Conclusions Key points to perform sleeve and wedge parenchyma-sparing bronchial resection: Key points to perform sleeve and wedge parenchyma-sparing bronchial resection: ● A benign or low-grade malignant bronchial lesion without extrabronchial spread ● A small basis of implant of the lesion and a normal bronchial tree at its periphery ● Absence of hilar or mediastinal nodal metastasis

14. Conclusions Conclusions Intraoperative bronchoscopic guide is a necessary tool to cut the bronchial wall adequately close to the lesion. Intraoperative bronchoscopic guide is a necessary tool to cut the bronchial wall adequately close to the lesion. Tumor obstructed the lumen of respiratory airway – obstructive pneumonia ( laser treatment + rigid bronchoscope) Tumor obstructed the lumen of respiratory airway – obstructive pneumonia ( laser treatment + rigid bronchoscope) Intraluminal bronchial tumor extended to segmental bronchi, particularly locating in the left or right upper lobes. --- difficulty to treatment Intraluminal bronchial tumor extended to segmental bronchi, particularly locating in the left or right upper lobes. --- difficulty to treatment

15. Conclusions Conclusions Bronchoplastic procedures without resection of lung parechyma – adequate, fascinating technique for low- grade endobronchial neoplasms. Bronchoplastic procedures without resection of lung parechyma – adequate, fascinating technique for low- grade endobronchial neoplasms.

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