Precise and fast video assisted thoracoscopic bronchial sleeve resection in the future

Surgical management for lung cancer is basically a destructive one. The lung parenchyma removed is in the balance between the purpose of curative resection and the preservation of patient’s lung function. Bronchial sleeve has been alternatively developed to achieve the same purpose, but through a different way—to save back healthy lung tissue through reconstruction of the central airway. Sleeve resection had been done with open technique for years, and just like the other thoracic operations, has continuously evolved into the era of minimally invasive surgery in spite of its difficulty. With rapid advancement and availability in technology—high resolution 3-D dynamic chest computed tomography (CT), PET-CT, and endobronchial ultrasound (EBUS), these tools are very helpful for us to have more precise tumor staging, and suitable for preoperative surgical planning. Under magnified 3-D endoscopic view and modified endoscopic suturing method, re-anastomosis of the airway could be easier and quicker, which would facilitate this innovative operation to accumulate experience in the not too distant future.