Simulation for Technical Challenge: Complete Portal Robotic Distal Tracheal and Left Main Stem Resection and Reconstruction on ECMO

A 15-year-old girl initially presented with complete obstruction of her left main stem bronchus with complete atelectasis of the left lung. She had been like this for one year. The left main stem was cleared with a bronchoscope and the lung re-expanded. The diagnosis was a granular cell tumor of the distal left side of the trachea and left main stem bronchus. She and her parents requested a minimally invasive approach. Initially, the authors thought this would not be possible. However, with continued improvement in minimally invasive technique, they changed their opinion. They prepared for the procedure by performing the operation on a cadaver. Using the lessons learned and knowledge gained from this cadaveric simulation, they then performed the procedure on the patient. The patient did well, and she returned to school two weeks following the procedure. This video demonstrates the cadaveric procedure as well as the carinal resection and reconstruction.

Suggested Reading

1. Schiavon M, Marulli G, Zuin A, Rea F. Technical options in carinal resection and reconstruction. https://www.ctsnet.org/article/technical-options-carinal-resection-and-reconstruction Published October 14, 2012. Accessed November 14, 2018.
2. Grillo HC. Carinal reconstruction. Ann Thorac Surg. 1982;34(4):356-373.