Pulmonary lobar root clamping and stapling technique: return of the "en masse lobectomy"

Most thoracic surgeons have experienced difficulty dissecting the pulmonary hilus because of scarring. In such potentially dangerous situations, we advocate a method of clamping and severing the pulmonary lobar root structure en masse. The aim of this study was to evaluate en masse lobectomy, particularly considering the constellation of pulmonary vessels and the bronchus.

Twelve patients (median age 70 years) underwent en masse lobectomy. We retrospectively evaluated the surgical procedures and clinical outcomes. Care was taken to consider the remaining vessels and bronchus, which regulate the direction of device placement.

Seven patients had inflammatory lung disease, four had primary pulmonary carcinoma, and one had suffered blunt chest trauma. Ten operations were elective and two were emergent. Lobectomy included the right upper lobe in two cases, the right middle lobe in three, the right lower lobe in two, the right middle-lower lobe in two, and the left lower lobe in three. A stapler was used in ten patients, and sutures were applied in three (both were used in one case). Morbidities included a pyothorax and a persistent air leak; both made a recovery. Mortality included one emergency case of acute respiratory distress syndrome. No bronchopleural or bronchovascular fistulas occurred.

We believe that the en masse lobectomy is an alternative and necessary technique in critical or unexpected situations, possibly as a last resort. Trauma and severe inflammation may be good indications for en masse lobectomy.