Right thoracotomy for carinal resection with left thoracoscopic pneumonectomy as a new approach for left sleeve...

A 43-year-old woman, with a history of asthma that had been treated for the previous 3 years, was diagnosed with an endobronchial tumor, based on chest computed tomography. A biopsy proved the tumor to be adenoid cystic carcinoma. For carinal involvement and submucosal extension in the left main bronchus, rigid bronchoscopy was done to maintain airway patency, and then a left sleeve pneumonectomy was done via a right thoracotomy and left video-assisted thoracoscopic surgery. The distance between the tumor-free left main bronchus and the carina was large; therefore, preservation of the left lung would have compromised the healing of the carinal tracheobronchoplasty and led to life-threatening complications. This case revealed that endobronchial lesions should be highly suspected after treatment for asthma fails. It also highlighted that, because the carina naturally deviates to the right, combined right thoracotomy and left video-assisted thoracoscopic surgery for left sleeve pneumonectomy provides an anatomical advantage for carinal tracheobronchoplasty. Furthermore, the combination reduces the postoperative physiological burden that could be caused by bilateral thoracotomy.