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