Preprocedural Planning
Preoperative planning includes the following:
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History and physical examination, including past history of radiation exposure and thoracic procedures
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Chest radiograph
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Chest CT scan with IV contrast
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PET scan
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MRI of the brain with IV contrast (brain CT with IV contrast if the patient has severe claustrophobia)
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Bronchoscopy
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Pulmonary function test
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Lung perfusion quantitation scan (calculate predicted postoperative lung function)
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Pathologic evaluation of mediastinal lymph node status via endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) or cervical mediastinoscopy
Patient Preparation
Anesthesia
Endotracheal intubation is performed using a single-lumen endotracheal tube (SLETT). Bronchoscopy is performed to identify the exact location and extension of the endobronchial tumor when present. The condition of the mucosa, including any erythema or nodularity, should be noted and biopsies taken if indicated to determine future margins of resection.
Lung isolation is usually obtained by exchanging the SLETT for a double-lumen endotracheal tube (DLETT) under bronchoscopic guidance to avoid accidental trauma to the endobronchial tumor Correct placement of the endotracheal tube is confirmed. Some surgeons may elect to use an endobronchial blocker if the endobronchial tumor is distal to the mainstem bronchus.
