Uniportal video assisted thoracoscopic surgery (U-VATS) with bronchotomy and bronchial reconstruction for removal of a key lodged in the bronchus intermedius, a novel case report from the heart of Africa

Background Foreign body (FB) aspiration is a potentially life-threatening condition, particularly in children, and requires prompt and effective management. While rigid and flexible bronchoscopy remain the primary methods of extraction, some cases present with persistent symptoms such as chronic cough or recurrent pneumonia, necessitating surgical intervention. This report presents the first documented case of FB extraction via uniportal video-assisted thoracoscopic surgery (uVATS) combined with bronchotomy and bronchial reconstruction—a novel surgical approach for complex cases.

Methods & Materials A 14-year-old girl with a two-year history of recurrent pulmonary infections and failed bronchoscopic removal of a key lodged in her airway was referred for surgical management. Imaging revealed the key wedged between the right main bronchus and bronchus intermedius. A decision was made to perform uVATS with bronchotomy. A 3-cm incision was made along the right fourth intercostal space. Using a 30-degree, high-definition, 10-mm thoracoscope and standard uVATS instrumentation, a right main bronchotomy was performed. The foreign body was identified at the entrance of the right upper bronchus and extracted via careful dissection. The bronchus was reconstructed in an elliptical fashion and closed with a 4–0 polypropylene barbed suture, followed by intrathoracic lavage. The lung was inflated under direct vision, and a 26-French chest tube was placed.

Results Total operative time was 45 minutes. The postoperative course was uneventful, with chest tube removal on postoperative day one and discharge on day two without complications. At three-month follow-up, the patient showed complete recovery with no residual symptoms or postoperative complications.

Conclusion This case illustrates the feasibility and safety of bronchotomy with bronchial reconstruction via uVATS for foreign body extraction from the airway. The procedure was cost-effective, minimally invasive, and resulted in excellent cosmetic and clinical outcomes. It also underscores the value of advanced thoracoscopic training, particularly in resource-limited settings.

Publication History

Article published online:
25 August 2025