The time-honored left pneumonectomy

With expanding experience in bronchial and vascular sleeve resections, pneumonectomy is avoidable in many cases, however, the thoracic surgeon will be presented with cases in his or her career for which resection is only possible by pneumonectomy. In their review, Kostoulas et al. provide a thorough review of surgical technique for left pneumonectomy, highlighting several key pearls and pitfalls. Similar to the authors’ technique, we begin every case with a flexible bronchoscopy to assure that an R0 bronchial resection margin is technically feasible. We similarly prefer a right-sided double-lumen endotracheal tube (ETT); however, the readers should understand that a left-sided bronchial blocker placed through a single lumen endotracheal tube is a possible alternative, and should pay close attention that is removed before clamping or dividing the left mainstem bronchus.