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Summary

Bronchovascular sleeve resection is the surgery for the treatment of central lung tumours that have spread to the pulmonary artery. During the surgery, the surgeon removes the affected parts of the bronchus, upper lobes of the lungs, and pulmonary artery and reconnects the open ends of the bronchus and pulmonary artery. Different tests such as blood tests, computed tomography scan, fibreoptic bronchoscopy, and X-ray are performed before the surgery to assess the tumour. The surgery will be performed with general anaesthesia, you will be asleep during the procedure. After the surgery, you will need a hospital stay of about five to 10 days. Your surgeon will prescribe medications to relieve the pain that you may experience after the surgery. 

Your follow-up will take place in two to six weeks, but you should visit the doctor at the earliest if you notice any unpleasant symptoms such as swelling or redness at the operation site or foul odour from the surgical wound. Some possible risks of this surgery include infections, bleeding, and leakage in the anastomosis.

  1. What is bronchovascular sleeve resection?
  2. Why is bronchovascular sleeve resection recommended?
  3. Who can and cannot get bronchovascular sleeve resection?
  4. What preparations are needed before bronchovascular sleeve resection?
  5. How is bronchovascular sleeve resection done?
  6. How to care for yourself after bronchovascular sleeve resection?
  7. What are the possible complications/risks of bronchovascular sleeve resection?
  8. When to follow up with your doctor after a bronchovascular sleeve resection?
Doctors for Bronchovascular Sleeve Resection

Bronchovascular sleeve resection is a surgical treatment for tumours in the central region of lungs (within 10 mm of the bronchus) that have spread to the lung region of the pulmonary artery.

When you breathe, the air enters your nose and then moves down to your windpipe or trachea. The trachea splits into two pipes known as bronchi that each enters the right and left lung. The right lung has an upper, middle, and lower lobe while the left lung has only an upper and lower lobe. Inside lungs, bronchi are further split into multiple small pipes known as bronchioles. These bronchioles contain very small air sacs at the end known as alveoli. The exchange of oxygen to the blood and carbon dioxide from the blood takes place in the alveoli.

Pulmonary artery is a blood vessel that carries oxygen-poor blood from the right ventricle [one of the four chambers of the heart] to the lungs.

Bronchovascular sleeve resection is performed for the treatment of cancer in the central lung area including pulmonary artery.

Initially, lung cancer does not show any symptoms. However, the following symptoms show up once the cancer progresses:

Bronchovascular sleeve resection cannot be performed if cancer has spread to areas of the lungs other than at the origin of a lobar bronchus (a division of the main bronchus) or lobar branches (that supply the lobe of the lung) of the pulmonary artery.

The following preparations are needed before this surgery:

  • Your doctor will note down your complete medical history and perform a physical examination to assess your overall health. 
  • He/she will order the following tests to diagnose the condition and identify the stage of cancer:
    • Computed tomography (CT) with a contrast medium (a substance used to increase the contrast of structures viewed during imaging procedures) of the chest and abdomen
    • Abdominal ultrasound
    • Fibreoptic bronchoscopy (a tube with a camera and light source is inserted into the windpipe) of the lungs to obtain samples for further study
    • Pulmonary function tests (tests to check the working of lungs).
    • Additional tests include blood tests, urine tests, a chest X-ray, and an electrocardiogram (ECG)
  • You will be asked to quit smoking before the surgery. This will help in reducing the risk of complications during and after the procedure.
  • You will be asked to perform certain exercises at home before the surgery to enhance the recovery process. 
  • Your doctor will ask you to fast from the midnight prior to the surgery.
  • Tell the doctor about all the medicines that you take. You may need to discontinue some medications like aspirin, warfarin, clopidogrel, and medicines containing vitamin E.
  • Arrange for someone who can take you home after the surgery.
  • If you agree to the procedure, you will have to sign a consent form. 

Once you reach the hospital, the hospital staff will give you a hospital gown and special stockings that prevent blood clots in your legs. They will start an intravenous line in your arm to provide you with essential fluids and medicines during the surgery. A catheter (tube) will be attached into your bladder to drain urine. Also, you will be given antibiotics to prevent infections and heparin to prevent blood clots.

The surgery will be performed under general anaesthesia (medicine given to make you fall asleep). In the operation theatre, the following steps are performed for a bronchovascular sleeve resection:

  • The surgeon will make a cut between two of your ribs. It begins from below the shoulder blade and travels towards the nipple from under the armpit.
  • Then, he/she will separate your ribs to reach your lungs.
  • The surgeon will cut off the affected region of your bronchus and may remove the upper lobes of both your lungs. 
  • Then, he/she will reconnect the two ends of your bronchus (anastomosis) with the help of sutures (stitches). 
  • Once the bronchus resection takes place, the surgeon will cut off the diseased part of your pulmonary artery and rejoin the ends of the artery with the help of stitches.
  • To check if the cancerous cells have been completely removed, the surgeon will send the cut off tissues to a lab for testing.
  • He/she will place a drain in your chest to remove any excess fluids in your chest cavity.
  • Finally, the surgeon will close the cut with the help of stitches and cover it with Steri-Strips.

The surgery takes about five hours. After the procedure, you will be moved to the recovery room where your breathing, heart rate, and blood pressure will be continuously measured. You may need a face mask to supply oxygen and your doctor will give you medications to relieve pain. 

A therapist will teach you certain breathing exercises to keep up your lung health; make sure to do them as directed. On the next day of surgery, you will be made to sit on a chair and walk for a short distance. This will aid in keeping up your circulation and promote recovery.

The chest drains and catheter will be removed after a few days. Generally, a discharge is given on the day when the chest drain is removed.

Your surgeon may ask you to keep the following things in mind to take care of yourself at home after the surgery:

  • Pain management: Take the painkillers regularly. Once you feel like the pain subsides, you may be able to reduce the amount of medications. 
  • Bathing: You can take a bath as soon as you are comfortable. Pat the wound dry after taking the bath.
  • Wound care: Do not use any ointments and creams on the operated area until it is healed as these will make the wound area more susceptible to break down.
  • Work: Your doctor will tell you when you will be able to resume work depending on the type of job and your recovery.
  • Activities: You may be able to perform light household chores and gradually increase the amount of work overtime. Your doctor may suggest you take regular walks. Do not carry heavy weights for at least three weeks. Work out regularly as suggested by the physician.
  • Driving: Avoid driving until you can move your arms and shoulders like before and have stopped taking pain medication.
  • Food: You will be asked to take a balanced meal, which is rich in proteins. Drink plenty of water throughout the day. This will help to keep your mucus thin so you can cough it out easily. Avoid taking caffeinated beverages to prevent constipation.

When to see the doctor?

Visit the doctor at the earliest if you have the following symptoms:

  • Opening of the incision
  • Increased pain despite taking painkillers
  • Increased breathlessness
  • Redness, swelling, or warmness at the incision site 
  • Any odour or cloudy fluid from the wound

Some of the possible complications of bronchovascular sleeve resection include:

Your follow-up will take place anytime between two to six weeks after your discharge, during which, the doctor will check your incision and remove your stitches.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

Dr Shubham Mishra

Dr Shubham Mishra

Pulmonology
1 Years of Experience

Dr. Deepak Kumar

Dr. Deepak Kumar

Pulmonology
10 Years of Experience

Dr. Sandeep Katiyar

Dr. Sandeep Katiyar

Pulmonology
13 Years of Experience

Dr. Rajendra Bera

Dr. Rajendra Bera

Pulmonology
16 Years of Experience

References

  1. Lausberg HF, Graeter TP, Tscholl D, Wendler O, Schafers H-J. Bronchovascular versus bronchial sleeve resection for central lung tumors. Ann Thorac Surg. 2005 Apr;79 (4):1147–1152
  2. Oxford University Hospitals [internet]: NHS Foundation Trust. National Health Service. U.K.; Lung resection
  3. National Health Service [Internet]. UK; Lung cancer
  4. Maurizi G, Andrilli AD, Venuta F, Rendina EA. Bronchial and arterial sleeve resection for centrally-located lung cancers. J Thorac Dis. 2016 Nov;8(Suppl 11):S872–S881. PMID: 27942409.
  5. Memorial Sloan Kettering Cancer Center [Internet]. New York. US; About Your Thoracic Surgery
  6. Stony Brook Cancer Center [Internet]. New York. US; Preparing for Lung Surgery
  7. Venuta F, Rendina EA. Combined pulmonary artery and bronchial sleeve resection. Gen Thorac Surg. 2008 Dec 1;13(4):260–273.
  8. Ito H, Nakayama H, Nagashima T, Samejina J. Bronchovascular sleeve resection of the right middle lobe in N1 lung cancer. AME Case Rep. 2019;3:5. PMID: 31020272.
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