2019 Volume 33 Issue 7 Pages 749-753
We report a left middle and lower sleeve lobectomy for lung cancer in a patient with complete situs inversus. A 76-year-old man complaining of bloody sputum was suspected of having lung cancer following sputum cytology. After computed tomography and bronchoscopy, the patient was diagnosed with squamous carcinoma cT2aN2M0 stage IIIA, which occluded the left lower bronchus and invaded the truncus intermedius. Differential ventilation was facilitated by inserting an inverted left double lumen tube into the right main bronchus, because the right and left bronchi were inverted, and left middle and lower sleeve bilobectomy was planned. Posterolateral thoracotomy with thoracoscopy was performed. Intraoperative observations revealed a complete mirror image of the right thorax, which meant we had to pay more attention to the abnormal intrathoracic structures. However, once we had taken this anomaly into account, we were able to perform a bilobectomy without encountering any other difficulties. The operative time was 398 minutes, and blood loss was 438 mL without transfusion. In this case, the most important considerations were careful management during the operation due to the mirror image of the right thorax, and successful execution of the intubation method to enable bronchoplasty and bronchoscopic observation.
