RIGHT-SIDED APPROACH FOR LEFT MAIN BRONCHIAL SLEEVE RESECTION IN ADENOID CYSTIC CARCINOMA: TECHNICAL NUANCES AND INNOVATION IN AIRWAY MANAGEMENT hema.siri3@gmail.com

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RIGHT-SIDED APPROACH FOR LEFT MAIN BRONCHIAL SLEEVE RESECTION IN ADENOID CYSTIC CARCINOMA: TECHNICAL NUANCES AND INNOVATION IN AIRWAY MANAGEMENT

3

India

Video

Central airway tumors involving the left main bronchus (LMB) present a formidable surgical challenge due to proximity to the carina, limited exposure, and the need for precise reconstruction. Adenoid cystic carcinoma, though slow-growing, demonstrates submucosal and perineural spread, necessitating complete resection. In resource-limited settings, technical adaptations are critical to achieve oncologic and functional outcomes while avoiding dependence on costly adjuncts such as ECMO or specialized jet ventilation

We present a 27-year-old male with chronic cough and hemoptysis. Bronchoscopy revealed a nodular lesion involving 50% of the LMB circumference, 1 cm distal to the carina. Histology confirmed adenoid cystic carcinoma. Surgery was performed in the left lateral decubitus position via a right-sided approach, beginning uniportal VATS and later converting to posterolateral thoracotomy for exposure. Dissection included azygos division and complete subcarinal lymphadenectomy. Airway reconstruction was performed using continuous 4-0 delayed absorbable sutures.

A major intraoperative limitation was the absence of ECMO and jet ventilation. A novel, low-cost strategy of high-flow oxygenation via a 16G IV cannula provided adequate oxygenation and uninterrupted anastomosis. The patient recovered uneventfully, chest drains were removed on day 3, and he was discharged on day 4. Histopathology confirmed negative margins and uninvolved nodes.

Right-sided approach offers superior access to proximal LMB tumors. Innovative airway management using IV cannula oxygenation represents a safe, resource-optimized alternative in low-resource settings. This strategy emphasizes adaptability, avoids ECMO-associated risks and costs, and ensures curative resection in young patients requiring parenchyma-sparing surgery.

https://vimeo.com/1110693098/f8960f6ec3