Uniportal VATS Left Lower Sleeve Lobectomy With Upper Lobe Bronchial Reimplantation for Typical Carcinoid Tumor

This video demonstrates the surgical management of a 36-year-old non-smoking female who was diagnosed with a typical carcinoid tumor involving the left lower lobe bronchus. The diagnosis was established through endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), and further evaluation with computed tomography (CT) and PET-DOTANOC imaging revealed a 25 mm centrally located hilar lesion without mediastinal involvement. Bronchoscopic assessment demonstrated a highly vascularized endobronchial mass that caused more than 75 percent obstruction of the left lower lobe bronchus, originating from segment B6 and extending to the inferior lobar bronchial wall, while preserving patency of the basal segments.

Given the central location of the tumor and the patient’s preserved pulmonary function, a parenchyma-sparing approach was preferred. A uniportal video-assisted thoracoscopic surgery (VATS) left lower sleeve lobectomy with bronchial reconstruction was performed through a single incision in the fourth intercostal space. Following fissure completion and the division of the pulmonary vessels using endoscopic staplers, a systematic lymphadenectomy of stations 7, 9, 11, and 12 was carried out. The upper lobe bronchus was carefully isolated, and a bronchotomy was performed. The lower lobe bronchus was resected with a proximal margin at the main bronchus.

Subsequently, the upper lobe bronchus was reimplanted into the main bronchus using a continuous 4-0 Prolene suture with a parachute technique. Intraoperative air leak testing was negative, and a single chest drain was placed.
The postoperative course was uneventful. Final histopathological analysis confirmed a typical carcinoid tumor staged as pT1cN1 with complete (R0) resection and one involved N1 lymph node. The bronchial margins were negative.

After a multidisciplinary discussion, a surveillance strategy was adopted.
This case highlights that uniportal VATS sleeve lobectomy with bronchial reimplantation is a feasible and effective technique for centrally located carcinoid tumors. It allows for complete oncologic resection while preserving lung parenchyma and demonstrates the expanding role of advanced bronchoplastic procedures in minimally invasive thoracic surgery.

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