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Right Middle Lobectomy Sleeve Resection for Primary Pulmonary Synovial Sarcoma; A Rare Operation for a Rare Condition
Zachary Brennan1, Tyler Wallen2, Mauricio Pipkin3, Tiago Machuca3.
1Michigan State University, East Lansing, MI, USA, 2Geisinger Health System, Wilkes-Barre, MI, USA, 3University of Florida, Department of Surgery, Division of Thoracic Surgery, Gainesville, FL, USA.

OBJECTIVE: The patient is a 44-year-old female with a past medical history significant for a cough and multiple rounds of treatment for pneumonia. She underwent a bronchoscopic evaluation which demonstrated a lesion at the take-off of the right middle lobe. Biopsy was consistent with synovial sarcoma and she was offered resection.
RESULTS:We preformed a right postero-lateral thoracotomy in the 5th interspace. The inferior pulmonary ligament was dissected. The PA was dissected in the fissure and a tunnel was created so we could complete the longitudinal fissure posteriorly, using the endostapler. The middle lobe branches of the PA and the middle lobe pulmonary vein were dissected, encircled and ligated with a vascular endostapler. The bronchus intermedius was opened after the take off. We transected the lower lobe bronchus just proximal to the take-off of the superior segmental bronchus. A bronchial anastomosis was then performed with the bronchus intermedius to the lower lobe bronchus. We used a running 4-0 PDS in the cartilaginous wall and several single sutures with 4-0 prolene to complete the membranous wall. The intercostal muscle flap was then buttressed between the anastomosis and the pulmonary artery stump. Finally, we completed the mediastinal lymphadenectomy.
CONCLUSIONS: The patient made an uneventful recovery and was discharged home. Pathologic analysis demonstrated negative bronchial margins as well as negative lymph nodes. Here we demonstrate our technique for a right middle lobe sleeve resection for a primary pulmonary synovial sarcoma; an unusual operation for an unusual tumor.


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