EVOLUTION OF PULMONARY RESECTION TECHNIQUES AND REVIEW OF THE BRONCHUS-FIRST METHOD

The dissection technique of pulmonary resection evolved in the period 1930 to 1950. Surgeons had to cope with the location of disease, bronc hiectasis, tuberculosis, and lung cancer, as well as associated bronch ial secretions, hilar pathology, and the status of anesthesiology. Two basic hilar dissection methods emerged, the anterior vessel-first seq uence and the posterior bronchus-first method. The bronchus-first meth od is particularly suitable for pneumonectomy, right upper lobectomy, and posterior-apical segmentectomy of this lobe as well as ease of lym ph node removal. This technique, as a primary method of lung resection , does not appear to be emphasized in teaching curricula and supportin g atlases or texts.