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, bronchiectasis, tuberculosis, and lung cancer, as well as associated bronchial secretions, hilar pathology, and the status of anesthesiology. Two basic hilar dissection methods emerged, the anterior vessel-first sequence and the posterior bronchus-first method. The bronchus-first method is particularly suitable for pneumonectomy, right upper lobectomy, and posterior-apical segmentectomy of this lobe as well as ease of lymph node removal. This technique, as a primary method of lung resection, does not appear to be emphasized in teaching curricula and supporting atlases or texts.