Background
Double sleeve (bronchovascular) lobectomy is a feasible alternative to pneumonectomy if a complete resection can be achieved in patients with centrally located non–small cell lung cancer (NSCLC) involving both the bronchus and the pulmonary artery (PA).
Traditionally, this technique has mainly been performed through a posterolateral thoracotomy, because of the high complexity of the airway anatomy and of arterial reconstruction. Technical advances and more experience gained in video-assisted thoracic surgery (VATS) over the past few decades have allowed some surgeons to achieve proficiency in performing double sleeve lobectomies by VATS. [1, 2] The introduction of robotic-assisted technology in thoracic surgery has spurred interest in performing more complex operations, and a few cases describing double sleeve resections with a robotic approach have been reported. [3, 4, 5]
Indications
Double sleeve lobectomy is indicated for NSCLC requiring bronchial and arterial reconstruction for R0 resection, such as in the following circumstances:
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Primary tumor involving the ongoing pulmonary artery and the bronchial wall
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Bulky peribronchial and perivascular metastatic nodal disease inseparable from the ongoing pulmonary artery and bronchial wall.
Contraindications
Contraindications to double sleeve lobectomy are as follows:
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Complete resection (R0) not achievable by bronchovascular sleeve resection
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Metastatic disease to lung (ie, the lung is not the primary site)
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Recurrent lung cancer
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Small cell lung cancer
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Metastasis to mediastinal (N2) lymph nodes (relative contraindication)
