Figure 4 Axial view HRCT lung image conforming the presence of congenital lobar emphysema of right middle lobe.
(Image Credits: Dr. Viral B. Patel)
The lobectomy was planned after weighing the benefit-risk of surgical resection with a thorough literature review. Right middle lobe resection was performed at 8 months and 9 days of age. The baby was placed in the left lateral position, chest cavity entered through the right 4th intercostal space. Dissection was done by Reverse Chamberlain Method from the periphery towards the hilum all around the fissure.The right middle lobe vein was identified and ligated proximally and branches were individually tied. The right middle lobe artery entering the right middle lobe was identified and branches were separated. The brisk nature of bleeding was controlled by hemostasis using electro-cautery. A bronchial clamp was applied after the right middle lobe bronchus was slinged by the rubber tubes. Right middle lobe bronchus divided proximal to the bronchial clamp. Single lung anesthesia was commenced. The divided bronchial stump is closed with multiple interrupted vertical mattress 5/0 polypropylene sutures. Stump integrity is checked underwater with sustained ventilation. A minor leak was noted from the lung parenchymal surface and no leak was noted from the bronchial stump. The right upper lobe and right lower lobe surfaces adhered together with two interrupted 5/0