Extrapericardial pneumonectomy

Presentation of the technique of extrapericardial left and right standard pneumonectomy. After insertion of a disposable double-lumen endotracheal tube, the patient is positioned in lateral decubitus and a lateral thoracotomy is performed. One-lung ventilation is started after a thorough identification is performed followed by systematic nodal dissection. Centrally, the pulmonary artery and veins are encircled, cut on clamps and sewed. Alternatively, the vessels can be stapled. Next, the bronchus is dissected toward the trachea and transected by stapling or interrupted sutures as close to the trachea as possible. When there is a high risk of bronchopleural fistula, as after induction chemotherapy or radiotherapy, the bronchial stump is covered with viable tissue (as azygos vein, pericardial fat, intercostal muscle or pleural flap, omentum, or muscle flaps from the thoracic wall).