Aspergilloma of the Lung: Strategy to Prevent Endobronchial Spillage.
Aspergilloma of the lung eroding into the airway may lead to perioperative endobronchial spillage and contamination of the normal lung. Our aim in this group of patients who are undergoing robotic- or video-assisted thoracoscopic lobectomy is to protect the contralateral lung and, if possible, uninvolved lobes of ipsilateral lung. Double-lumen endobronchial tubes do provide lung protection to the contralateral lung intraoperatively, but there is no protection to the ipsilateral lung lobes not involved by the disease process. Moreover, there is no lung protection against endobronchial spillage during the period of induction of general anesthesia, when the cough reflex and gag reflex are absent. We have devised a technique to advance from side selection to lobe selection, that is, selective lobar isolation to prevent perioperative contamination of uninvolved lung lobes. This technique has two components viz positioning of the patient and securing the airway. The technique can also be used in other conditions such as hydatid cyst of the lung, lung abscess communicating with the airway and bleeding into the airway.
From the Departments of *Anaesthesia and Critical Care and †Thoracic Surgery, Medanta, The Medicity, Gurgaon, India.
Preety Mittal
PM
Roy
Sangeeta
S
Khanna
Yatin
Y
Mehta
Ali Zamir
AZ
Khan
D006348:Cardiac Surgical Procedures / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008168:Lung / Q000382:microbiology; D055732:Pulmonary Aspergillosis / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods