V-Shaped Incision of the Proximal Cartilage for High-Caliber Mismatch in Bronchoplasty

Background

The problem of high-caliber mismatch in bronchoplasty is not uncommon. This report describes a technique using a V-shaped proximal cartilage incision to adjust high-caliber mismatch.

Methods

Among 255 patients who underwent tracheoplasty or bronchoplasty at a single institution (Juntendo University School of Medicine, Tokyo, Japan) between February 2008 and December 2022, 12 patients (4.7%) who underwent bronchoplasty with a proximal cartilage V-shaped incision for the adjustment of high-caliber mismatch were investigated. Bronchial anastomosis was performed using a continuous running monofilament suture at the bottom of the cartilage. Interrupted 3-0 or 4-0 monofilament sutures were used for the remaining cartilaginous tissue. Before completing the cartilaginous suture, a V-shaped incision was made in the proximal cartilage at the junction of the membranous portion. The cartilage and membranous portion of the incision were sutured using 3 interrupted sutures with 4-0 polydioxanone sutures. Finally, the membranous portion was sutured to complete the anastomosis.

Results

Eleven patients were men, and the median age was 66 years. The histologic diagnoses were adenocarcinoma in 2 patients and squamous cell carcinoma in 10 patients. Three patients underwent operation after definitive chemoradiotherapy. Right sleeve pneumonectomy, right upper sleeve lobectomy, type A extended-sleeve lobectomy, and type C extended-sleeve lobectomy were performed in 7 patients, 3 patients, 1 patient, and 1 patient, respectively. No anastomotic complications were observed. The V-shaped incision group had a significantly higher frequency of right sleeve pneumonectomy than the group without the V-shaped incision (P < .01).

Conclusions

Creation of a proximal cartilaginous V-shaped incision is a useful technique for adjusting high-caliber mismatch, especially in right sleeve pneumonectomy.