case_images: PMC10912180_01
case_images: PET revealed a 61.7-mm x 43.9-mm tumor near the left hilum (A). PET examination after immunotherapy revealed that the tumor was 45 mm x 44 mm (B). Bronchoscopy result (C). Contrast-enhanced CT revealed that the tumor invaded the left upper bronchus and the left upper artery (D).
case_images: fsurg-11-1360125-g001.jpg
case_images: PMC10912180_01_fsurg-11-1360125-g001.jpg
case_images: F1
case_images: A 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed increased accumulation of FDG in the mass (standardized uptake value: 15.08) and in the enlarged lymph node at the left hilum (standardized uptake value: 5.78) (Figure 1A). The bronchoscopy confirmed the mass at the origin of the light upper lobe bronchus (Figure 1B). PET examination after completing three cycles of immunotherapy revealed the mass was 45 mm x 44 mm in size and the standardized uptake value was 12.31 (Figure 1C). Preoperative contrast-enhanced CT revealed tumor infiltration of the left upper bronchus and PA (Figure 1D). A figure showcasing the timeline of the patient is presented in Supplementary Figure S1.
case_images: Intraoperative view. (A) Left main PA was blocked by a bulldog clamp. (B) Distal PA was blocked by a bulldog clamp. (C) Left main PA was transected by the robotic scissor. (D) Left main bronchus was cut open by the robotic scissor.
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case_images: PMC10912180_01_fsurg-11-1360125-g002.jpg
case_images: F2
case_images: A bulldog clamp was placed to block off the proximal left main PA (Figure 2A) and another bulldog clamp was placed at the origin of A6 to block off the distal PA (Figure 2B). We cut open the blocked PA between the two bulldog clamps (Figure 2C). Subsequently, the left main bronchus was cut open proximal to the origin of the left lower bronchus (Figure 2D).
case_images: Intraoperative view. (A) Anastomosis of the left main bronchus and the left lower bronchus. (B) Tracheal anastomosis was completed with a running suture. (C) Vascular reconstruction of the left main PA and the left lower PA. (D) Vascular reconstruction was completed by a running suture and fortified by a mattress suture.
case_images: fsurg-11-1360125-g003.jpg
case_images: PMC10912180_01_fsurg-11-1360125-g003.jpg
case_images: F3
case_images: First, the anastomosis of the bronchus was performed by an absorbable barbed double-needle 3-0 suture (Figure 3A). The membranous part was sutured first and then the cartilaginous part was sutured in a circumferential manner (Figure 3B). The artery angioplasty also began at the posterior wall of the interlobar artery and the left main PA (Figure 3C, Figure 4A). We employed another single-needle 5-0 prolene suture to fortify the anastomosis by mattress suture (Figure 3D).
case_images: Anastomosis of the left pulmonary artery and the left lower pulmonary artery with a running suture by using bulldog clamps (A). Bronchoscopy findings at the anastomotic site on the 50th postoperative day (B). Recent contrast-enhanced CT (C,D).
case_images: fsurg-11-1360125-g004.jpg
case_images: PMC10912180_01_fsurg-11-1360125-g004.jpg
case_images: F4
case_images: The artery angioplasty also began at the posterior wall of the interlobar artery and the left main PA (Figure 3C, Figure 4A). Bronchoscopy examination on the 50th postoperative day suggested satisfactory healing of the anastomosis (Figure 4B). A recent contrast-enhanced CT (9 months after the surgery) did not reveal any apparent complications or recurrence (Figures 4C,D).