Thoracoscopic-assisted right thoracic approach for resection of proximal left main bronchial adenoid cystic carcinoma

Adenoid cystic carcinoma (ACC) of the proximal left main bronchus is rare and presents significant surgical challenges due to its anatomical location. We report the case of a 31-year-old woman who presented with dyspnea caused by a proximal left main bronchial ACC. Initial bronchoscopic debulking provided histological diagnosis and symptomatic relief. For definitive staging, a post-debulking PET-CT confirmed the presence of residual metabolically active disease at the primary site and showed no evidence of distant metastasis. Definitive treatment involved thoracoscopic-assisted sleeve resection via a right thoracic approach under non-intubated anesthesia with high-frequency jet ventilation. The procedure was converted to a mini-thoracotomy due to excessive mediastinal movement during the anastomotic phase. R0 resection was achieved, and the postoperative course was uneventful. This case demonstrates the feasibility of a right-sided approach for low-grade bronchial malignancies when lung preservation is a primary goal, and highlights the role of thoracoscopic assistance throughout a hybrid procedure.