Foreign body removal by a lung-sparing bronchotomy.

This tutorial shows how to remove an aspirated foreign body via a lung-sparing operation using a transverse bronchotomy through a transthoracic approach.  An 18-year-old woman was admitted for treatment of an aspirated foreign body. A pushpin was impacted in a subsegmental branch of the right lower lobe of her bronchus. The problem was managed successfully using a conservative surgical approach:  The foreign body was removed from the lower-lobe bronchus, thereby avoiding the need for a lung resection. Starting with a posterolateral thoracotomy by harvesting a pedicled flap, the surgeon exposed and opened the bronchus to remove the impacted foreign body. The bronchial suture was covered by the pedicled flap.  The endoscopic removal of aspirated foreign bodies, which is considered the first-line treatment, can be challenging and can lead to airway injury or stenosis. Described at the beginning of 20th century, transthoracic bronchotomy for foreign body removal remains a life-saving and lung-sparing procedure that should not be overlooked.