Although bronchoplasty for malignant lung lesions is common, bronchoplasty for benign lung lesions is relatively rare. In most instances, these lesions are published as individual case reports, and various approaches and procedures have been performed. In this chapter, selected case reports of bronchoplasty for benign lung lesions are used to illustrate each disease entity. We begin with a description of the endobronchial Watanabe spigot, a newly developed instrument that is used to occlude the bronchus. Specific entities discussed in this chapter include bronchoplasty for tracheobronchomalacia, tuberculous bronchial lesions, endobronchial benign tumors, endobronchial inflammatory polyps, bronchial stenosis after bronchial anastomosis, and bronchial disruption.
Tracheobronchomalacia is characterized by weakness of the tracheobronchial wall and supporting cartilage. Collapsing airways owing to tracheobronchomalacia have been stabilized with a variety of external splints; for example, autologous rib and various types of prostheses have been used. A new technique in which a ringed polytetrafluoroethylene (PTFE) graft splint was placed for serious tracheobronchomalacia has been reported.1 The patient was 55-year-old man with grade 3 tracheobronchomalacia (Johnson's classification).2 Chest CT scan showed a crescent deformity of the trachea (Fig. 81-1A). Bronchoscopy revealed crescent-type stenosis (see Fig. 81-1B). Matsuoka and colleagues1 cut the 12-mm-diameter ringed PTFE graft to a length of 2.5 cm (Fig. 81-2A). The prosthesis was divided longitudinally and spread. The rings were cut at various points to fit the membranous portion of the trachea and bronchi (see Fig. 81-2B), after which the prosthesis was sutured to the cartilage and membranous portion with 4–0 PDS-II sutures (see Fig. 81-2C). This process was repeated from the trachea to the bilateral bronchi. The patient's symptoms were markedly improved after surgery. Postoperative chest CT scan showed that the caliber of the trachea was well preserved (Fig. 81-3).
A. Chest CT scan revealed a crescent deformity of the trachea. (Used with permission from Matsuoka H, Nishio W, Sakamoto T, et al: Use of span plasty with ringed PTFE for serious tracheobronchomalacia. Jpn J Chest Surg 16:602, 2002.)B. Bronchofiberscopic findings revealing a slitlike stenosis of crescent type. (Used with permission from Matsuoka H, Nishio W, Sakamoto T, et al: Use of span plasty with ringed PTFE for serious tracheobronchomalacia. Jpn J Chest Surg 16:602, 2002.)
A. A ringed PTFE with a diameter of 12 mm is cut to a length of 2.5 cm. B. After dividing the prosthesis longitudinally, it is spread. The rings are cut in various portions to fit the membranous portion of the trachea and bronchi. C. The reinforcement is first sutured to the edge of the cartilaginous rings with 4-0 PDS-II. It is then sutured in a ...