D110-01 Uniportal Thoracoscopic Sleeve Segmentectomy for Typical Carcinoid and Distal Infection: A Case Report

Abstract Introduction Bronchial carcinoid (BC) is a low-grade malignant tumor originating from neuroendocrine cells in the bronchial mucosa, accounting for approximately 1-2% of all lung tumors. Typical carcinoid (TC) constitutes about 90% of BC cases, often presenting with symptoms related to bronchial obstruction and is associated with a favorable prognosis. While surgical resection remains the definitive treatment, central tumors involving lobar bronchi present technical challenges, particularly when complicated by distal obstructive pneumonia. Traditional sleeve lobectomy, though effective, results in significant loss of functional lung parenchyma. We present a case demonstrating the feasibility and clinical utility of glasses-free 3D uniportal thoracoscopic sleeve segmentectomy as a lung-sparing alternative in this challenging clinical scenario. Case presentation A 26-year-old female (BMI: 17.69 kg/m²) was admitted due to hemoptysis. Contrast-enhanced CT revealed(Figure 1 a-b): ① a well-defined soft tissue nodule (approximately 1.5 × 1.0 × 1.2 cm) at the orifice of the right lower lobe bronchus, suggestive of a low-grade malignant tumor; ② no evidence of metastasis in the hilar or mediastinal lymph nodes; and ③ scattered obstructive pneumonia in the right lower lobe. Bronchoscopy showed a neoplasm obstructing the lumen at the right lower lobe bronchial orifice(Figure 1 c). The patient subsequently underwent glasses-free 3D uniportal thoracoscopic resection of the tumor at the right lower lobe bronchial orifice, sleeve segmentectomy of the superior segment, and lymph node dissection(Figure 1 d-h). The total operative time was 4 hours and 55 minutes, with an estimated blood loss of 20 ml. Postoperative pathological examination of the resected specimen confirmed the diagnosis of typical carcinoid (Figure 1 i). Discussion Sleeve segmentectomy, as performed in this case of a young patient with central carcinoid and distal infection, represents a significant innovation beyond conventional sleeve lobectomy. By avoiding anastomosis within infected tissue and preserving the functional basal segments, this approach effectively balances oncologic radicality and functional preservation. Traditional algorithms often recommend sleeve lobectomy for central tumors, even at the cost of healthy lung tissue; however, the presence of purulent secretions and inflammation in this case made a triple sleeve resection hazardous. The uniportal thoracoscopic technique enabled precise bronchial anastomosis despite the challenging operative conditions, demonstrating that complex bronchial reconstruction remains feasible via a minimally invasive approach in selected patients with infection. Thus, uniportal sleeve segmentectomy offers a safe, lung-preserving alternative in carefully selected cases, warranting further evaluation as a potential paradigm shift in managing central airway tumors with obstructive complications. This abstract is funded by: None