Rare Middle Lobe Lung Lobectomy: Clinical Case

Nairi Medical Center recently established a Thoracic Surgery Service, where in addition to surgeries, consultations and other procedures for lung pathologies are performed. Although the service is relatively new, complex surgeries are already being carried out. One of the recent cases was a middle lobe lobectomy.

We spoke with Dr. Armen Khanoyan, thoracic surgeon at Nairi Medical Center.

– How would you describe the surgery performed?
– A 43-year-old patient was admitted to Nairi. The year before, he had undergone cholecystectomy and appendectomy. During preoperative diagnostics, an X-ray revealed pathological changes in the middle lobe of the right lung, initially interpreted as an inflammatory process and treated with antibiotics. The patient had minimal complaints — only mild weakness and occasional cough.

A follow-up CT scan a month later showed no improvement. The middle lobe was not participating in breathing and was in a state of atelectasis. In medicine, the “middle lobe syndrome” is a known condition, where the first concern is always to exclude a tumor.

Bronchoscopy revealed deep-seated pathology in the subsegmental bronchi of the middle lobe. Biopsy confirmed sarcoidosis — a disease of unknown cause, mainly affecting the lungs and lymph nodes, less commonly the skin, eyes, and other organs. Importantly, it is not considered a tumor.

Histological differentiation of sarcoidosis from tuberculosis is difficult, but we succeeded. Given that the lobe had practically lost function due to fibrosis, surgical removal was deemed necessary. After discussing options with the patient, a thoracoscopic lobectomy was chosen, offering minimal trauma, excellent cosmetic results, shorter hospitalization (3–4 days), and easier recovery.

The surgery was performed with the support of Professor Andranik Adamyan, Doctor of Medical Sciences. On the 4th day, the patient was discharged in good condition and high spirits.

– How often are such surgeries performed?
– The choice depends on indications for open versus closed approaches, but the trend is increasingly toward thoracoscopic surgeries. While more costly and technically demanding, their advantages for patients — lower risks, faster recovery, better quality of life — are undeniable. Medicine must always move forward, striving for more.