title: Lady Windermere revisited: treatment with thoracoscopic lobectomy/segmentectomy for right middle lobe and lingular bronchiectasis associated with non-tuberculous mycobacterial disease.
abstract: OBJECTIVE
  Lady Windermere syndrome is a well-known but poorly understood female predominant phenotype of isolated right middle lobe and lingular bronchiectasis associated with non-tuberculous mycobacterial (NTM) infection. Despite lengthy multidrug antibiotic treatment, the presence of damaged parenchymal tissue leads to symptomatic disease recurrence, often with resistant organisms. The use of surgical resection as an adjunct to medical therapy may alter this cycle, although little is known about the use of thoracoscopic lung resection in this patient population.
  
  
  METHODS
  This is a retrospective review of a prospectively collected database of patients with pulmonary NTM disease from July 2004 to December 2009. All patients had focal bronchiectasis of the right middle lobe and lingula, treated with targeted antimicrobial therapy for several months prior to resection.
  
  
  RESULTS
  A total of 134 patients underwent 172 operations, with 38 patients having staged bilateral resections. The cohort was predominately female (96%) and Caucasian (95%), with a mean age of 59 years (range 34-81 years). Using a thoracoscopic approach in all patients, 102 middle lobectomies and 70 lingulectomies were performed. Conversion to open thoracotomy occurred in five cases (3%). Secondary procedures were performed in 20 cases (12%). There was no operative mortality. Postoperative morbidity was noted following 12 operations (7%), primarily consisting of prolonged air leak. The mean length of stay was 3.3 days (range 1-15 days).
  
  
  CONCLUSIONS
  Although medical therapy remains the primary treatment modality for patients with pulmonary NTM disease, the selective use of pulmonary resection may reduce the incidence of symptomatic disease recurrence. The addition of thoracoscopic resection to treatment regimens for patients with Lady Windermere syndrome can be accomplished with minimal morbidity and mortality.
authors.affiliation: Section of General Thoracic Surgery and the Center for the Surgical Treatment of Lung Infections, Division of Cardiothoracic Surgery, University of Colorado Denver School of Medicine, Aurora, CO, USA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Yu
authors.forename: Marvin
authors.initials: M
authors.lastname: Pomerantz
authors.forename: Amy
authors.initials: A
authors.lastname: Bishop
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Weyant
authors.forename: John D
authors.initials: JD
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001987:Bronchiectasis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D013577:Syndrome; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome