Right Upper and Middle Lobe Bronchoplasty

A right upper lobe tumor that involves the middle lobe parenchyma but spares the bronchus intermedius is best managed by right upper lobe bronchoplasty and standard in-continuity middle lobectomy (Figure 30-3B). This avoids a major size discrepancy between the right main bronchus and the right lower lobe bronchus. It is important to preserve the peribronchial tissue around the bronchus intermedius and middle lobe bronchus.

If it is necessary to remove the bronchus intermedius up to the right lower lobe bronchus, it is important to preserve as much of the right main bronchus as possible. Oblique transection of the right main bronchus may sometimes facilitate anastomosis, with the obliquity of division of the lower lobe bronchus, which is made necessary when the bronchus intermedius and middle lobe bronchus are removed (Figure 30-3C). This is necessarily done at an angle to preserve the superior segmental bronchus of the lower lobe. These steps will minimize size discrepancy and reduce tension as well. When the entire right main stem and bronchus intermedius are removed, it may be necessary to incise the pericardium beneath the inferior pulmonary vein to release the hilar structures and reduce anastomotic tension. The anastomosis is done as described for right upper lobe bronchoplasty.

Peripheral Neuropathy Natural Treatment Options

Peripheral Neuropathy Natural Treatment Options

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