Surgical techniques for thoracoscopic secondary carinal reconstruction with stepwise barbed sutures.

Parenchymal-preserving surgery is the preferred technique for selected patients with centrally located airway tumors limited to the secondary carina; however, reconstruction is challenging. We present a simplified video-assisted thoracoscopic surgery technique for secondary carinal reconstruction with three barbed sutures on each side. In each patient, the first thread was used to approximate the main bronchus and lower lobe bronchus on the left side or the bronchus intermedius and upper lobe bronchus on the right side. A horizontal mattress suture was critical to secure the backward joint section of the three bronchi with the second barbed thread. Finally, several interrupted stitches were used to finish the anastomosis following the third barbed suture. The method described here offers a feasible and reproducible option for complex airway reconstruction with a minimally invasive approach.