Right middle and lower bilobectomy using a modified fissureless technique: a case report

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Fissureless lobectomy is effective for preventing air leaks in specific lung conditions.
• It is also advantageous in complex lung cancer cases involving adjacent lobes.
• However, its application in bilobectomy procedures is less documented.

Purpose of the Study:

• To describe a modified fissureless technique for right middle and lower bilobectomy.
• To demonstrate the feasibility of this approach in a patient with advanced lung cancer and obstructive pneumonia.
• To highlight the benefits of lung capacity preservation compared to pneumonectomy.

Main Methods:

• A fissure-last right middle and lower bilobectomy was performed.
• The technique involved dividing the interlobar pulmonary artery before bronchial resection.
• This modified approach was used in a patient with a rapidly enlarging lung tumor invading multiple lobes.

Main Results:

• The fissureless bilobectomy was successfully completed.
• The patient was discharged 16 days post-surgery without complications.
• This technique successfully controlled infection and preserved lung function.

Conclusions:

• A modified fissureless technique for bilobectomy is feasible and beneficial.
• Dissecting the pulmonary artery before bronchus resection is a key technical detail.
• Familiarity with fissureless bilobectomy offers an alternative to right pneumonectomy.