Adenoid cystic carcinoma (ACC) of the proximal left main bronchus is rare and presents significant surgical challenges due to its anatomical location. We report the case of a 31-year-old woman who presented with dyspnea caused by a proximal left main bronchial ACC. Initial bronchoscopic debulking provided histological diagnosis and symptomatic relief. For definitive staging, a post-debulking PET-CT confirmed the presence of residual metabolically active disease at the primary site and showed no evidence of distant metastasis. Definitive treatment involved thoracoscopic-assisted sleeve resection via a right thoracic approach under non-intubated anesthesia with high-frequency jet ventilation. The procedure was converted to a mini-thoracotomy due to excessive mediastinal movement during the anastomotic phase. R0 resection was achieved, and the postoperative course was uneventful. This case demonstrates the feasibility of a right-sided approach for low-grade bronchial malignancies when lung preservation is a primary goal, and highlights the role of thoracoscopic assistance throughout a hybrid procedure.
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