Bronchial stapling and postoperative bronchoscopy was performed in 22 left upper lobectomies (LUL) and 18 right upper lobectomies (RUL). Seven LUL cases and 15 RUL cases with Staples positioned 2 bronchial rings (BR) from the entrance to the upper lobe bronchus (ULB) had no residual cartilaginous rings at the stump (RCRS). Deformity of the residual bronchus (DRB) was found in 6 of these 7 LUL cases, and 3 of these 15 RUL cases (p < 0.01), with a high rate of suffering from a severe cough. The remaining 15 LUL cases and 3 RUL cases had staples positioned 3 to 4 BR from the entrance to the ULB resulting in one or two RCRS. Only one LUL case with one RCRS was accompanied by DRB and coughing. These facts strongly imply a connection between cough and DRB. DRB was frequently seen in LUL cases with no RCRS (86%), was less likely to occur in cases with one RCRS (10%), and was absent in cases with two RCRS (p < 0.01). We conclude that bronchial staples applied during a LUL should be positioned 3 or 4 bronchial rings distal from the entrance to the left ULB.
Bronchial stapling - Upper lobe bronchus - Deformity of the residual bronchus - Cough - Residual cartilaginous ring
