Classics in thoracic surgery: Total pneumonectomy. Rudolf Nissen, M.D.

In July, 1931, a 12-year-old girl sustained a crushing injury to the thorax. Tension pneumothorax, which suggested a tear in the left main bronchus, developed. Because of chronic pulmonary suppuration over the next several months, the decision was made to extirpate the left lung. Total pneumonectomy was attempted, but during the operation strong traction on the hilum resulted in temprary asystole. The operation was halted and resumed fourteen days later. The lung was freed and suture ligatures tied around the hilum, central to the bronchial obstruction. Two weeks later the necrotic lung sloughed off. A small bronchial fistula closed spontaneously. The patient lived for several years. Haight and Graham completed successful pneumonectomies in 1933, Traham's procedure being accomplished in one stage. In the 49 years since the first pneumonectomy, little has been added to the technique, save the achievement of superior hemostasis.