{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:09:31Z","timestamp":1780070971183,"version":"3.54.0"},"reference-count":23,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,6]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>Intraoperative tracheobronchial injury is an uncommon but potentially life-threatening complication during thoracic surgery. We present two cases: one female patient in her 70s and another female patient in her 40s scheduled for robotic right upper and lower lobectomy respectively. Both cases were complicated by iatrogenic injuries to the left mainstem bronchus requiring repair. Successful management of the unanticipated iatrogenic injuries required ongoing communication and coordination between the anaesthesiologist and surgeon and a shift in ventilation strategies to adapt to surgical conditions and allow repair while maintaining a closed chest approach.<\/jats:p>","DOI":"10.1136\/bcr-2025-271541","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:55:27Z","timestamp":1780070127000},"page":"e271541","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Adaptive airway management of iatrogenic bronchial injury during lobectomy in two cases involving lung isolation"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6481-2933","authenticated-orcid":false,"given":"Chanbin","family":"Lee","sequence":"first","affiliation":[{"name":"Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Schadt","sequence":"additional","affiliation":[{"name":"Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley","family":"Leesley","sequence":"additional","affiliation":[{"name":"Thoracic Surgery, Brown University Health, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Ng","sequence":"additional","affiliation":[{"name":"Thoracic Surgery, Brown University Health, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Maslow","sequence":"additional","affiliation":[{"name":"Anesthesiology, Brown University Health, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzong-Huei","family":"Chen","sequence":"additional","affiliation":[{"name":"Anesthesiology, Brown University Health, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"2026052908552212000_19.5.e271541.1","doi-asserted-by":"crossref","first-page":"5698","DOI":"10.1038\/s41598-025-90052-w","article-title":"Excessive lymph node dissection increases postoperative cardiovascular disease risk in non-small cell lung cancer patients","volume":"15","author":"Liang","year":"2025","journal-title":"Sci Rep"},{"key":"2026052908552212000_19.5.e271541.2","doi-asserted-by":"publisher","DOI":"10.1016\/s0003-4975(03)00549-6"},{"key":"2026052908552212000_19.5.e271541.3","doi-asserted-by":"crossref","DOI":"10.1186\/s13019-021-01519-6","article-title":"The concept of broad exposure facilitates uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection","volume":"16","author":"Wang","year":"2021","journal-title":"J Cardiothorac Surg"},{"key":"2026052908552212000_19.5.e271541.4","doi-asserted-by":"crossref","DOI":"10.1186\/s13019-022-01758-1","article-title":"Chylothorax after pulmonary resection and lymph node dissection for primary lung cancer; retrospective observational study","volume":"17","author":"Yasuura","year":"2022","journal-title":"J Cardiothorac Surg"},{"key":"2026052908552212000_19.5.e271541.5","first-page":"100970","article-title":"Anaesthetic management of intraoperative tracheo-bronchial injury","volume":"29","author":"Singh","year":"2020","journal-title":"Respir Med Case Rep"},{"key":"2026052908552212000_19.5.e271541.6","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s00595-012-0315-5","article-title":"Intraoperative management of tracheobronchial rupture after double-lumen tube intubation","volume":"43","author":"Ceylan","year":"2013","journal-title":"Surg Today"},{"key":"2026052908552212000_19.5.e271541.7","doi-asserted-by":"crossref","first-page":"31","DOI":"10.21037\/ccts-24-30","article-title":"A review of managing catastrophes in robotic-assisted thoracic surgery","volume":"6","author":"Battan-Wraith","year":"2024","journal-title":"Curr Chall Thorac Surg"},{"key":"2026052908552212000_19.5.e271541.8","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.chest.2018.07.018","article-title":"Treatment of Tracheobronchial Injuries: A Contemporary Review","volume":"155","author":"Grewal","year":"2019","journal-title":"Chest"},{"key":"2026052908552212000_19.5.e271541.9","doi-asserted-by":"crossref","DOI":"10.3389\/fsurg.2023.1125997","article-title":"Post-intubation iatrogenic tracheobronchial injuries: The state of art","volume":"10","author":"Passera","year":"2023","journal-title":"Front Surg"},{"key":"2026052908552212000_19.5.e271541.10","first-page":"343","article-title":"Iatrogenic tracheobronchial rupture","volume":"7","author":"Paraschiv","year":"2014","journal-title":"J Med Life"},{"key":"2026052908552212000_19.5.e271541.11","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.7150\/ijms.75835","article-title":"A comparison between bronchial blockers and double-lumen tubes for patients undergoing lung resection: A propensity score-matched cohort study","volume":"19","author":"Yang","year":"2022","journal-title":"Int J Med Sci"},{"key":"2026052908552212000_19.5.e271541.12","first-page":"2751","article-title":"The efficacy and adverse effects of the Uniblocker and left\u2011side double\u2011lumen tube for one\u2011lung ventilation under the guidance of chest CT","volume":"19","author":"Liu","year":"2020","journal-title":"Exp Ther Med"},{"key":"2026052908552212000_19.5.e271541.13","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.3390\/jcm10081590","article-title":"Changes in the Bronchial Cuff Pressure of Left-Sided Double-Lumen Endotracheal Tube by Lateral Positioning: A Prospective Observational Study","volume":"10","author":"Kim","year":"2021","journal-title":"JCM"},{"key":"2026052908552212000_19.5.e271541.14","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12253"},{"key":"2026052908552212000_19.5.e271541.15","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/PTS.0000000000001098","article-title":"Closed-Loop Communication in Interprofessional Emergency Teams: A Cross-Sectional Observation Study on the Use of Closed-Loop Communication Among Anesthesia Personnel","volume":"19","author":"Gj\u00f8vikli","year":"2023","journal-title":"J Patient Saf"},{"key":"2026052908552212000_19.5.e271541.16","unstructured":"Kappus S , King O . Mediastinitis. In: StatPearls. Treasure Island FL: StatPearls Publishing, 2024."},{"key":"2026052908552212000_19.5.e271541.17","first-page":"E85","article-title":"Conservative management of post-intubation tracheal tears-report of three cases","volume":"6","author":"Ov\u00e1ri","year":"2014","journal-title":"J Thorac Dis"},{"key":"2026052908552212000_19.5.e271541.18","doi-asserted-by":"crossref","first-page":"214","DOI":"10.4103\/aca.aca_236_20","article-title":"Bronchial blocker and double-lumen endotracheal tube combination to facilitate lung isolation during esophagectomy","volume":"25","author":"Liang","year":"2022","journal-title":"Ann Card Anaesth"},{"key":"2026052908552212000_19.5.e271541.19","doi-asserted-by":"crossref","DOI":"10.1213\/XAA.0000000000001586","article-title":"Maintaining One-Lung Ventilation With an Endobronchial Blocker Through a Damaged Left-Sided Double-Lumen Tube: A Case Report","volume":"16","author":"Singley","year":"2022","journal-title":"A A Pract"},{"key":"2026052908552212000_19.5.e271541.20","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/ACC.0b013e31829459e6","article-title":"Failure of lung isolation by a double-lumen endotracheal tube rescued by the concomitant use of an arndt bronchial blocker under direct visualization","volume":"1","author":"Beam","year":"2013","journal-title":"A A Case Rep"},{"key":"2026052908552212000_19.5.e271541.21","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.bjae.2023.07.001","article-title":"Double-lumen tubes and bronchial blockers","volume":"23","author":"Patel","year":"2023","journal-title":"BJA Educ"},{"key":"2026052908552212000_19.5.e271541.22","doi-asserted-by":"crossref","first-page":"124","DOI":"10.4103\/aca.aca_140_22","article-title":"Choosing the correct-sized adult double-lumen tube: Quest for the holy grail","volume":"26","author":"Shah","year":"2023","journal-title":"Ann Card Anaesth"},{"key":"2026052908552212000_19.5.e271541.23","unstructured":"Lee C , Lee E , Maslow A , et al . Hybrid lung isolation technique for intraoperative repair of left mainstem bronchus injury during robotic right upper lobectomy. ePoster Presented at: American Society of Anesthesiologists 2025 Meeting; San Antonio, TX, USA,"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271541","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:55:31Z","timestamp":1780070131000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271541"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":23,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,29]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bcr-2025-271541"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271541","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}