Objective

A 40 year old man presents with a chronic productive cough and an abnormal chest radiograph. Subsequent CT scan revealed a subcarinal bronchogenic cyst compressing the right middle lobe bronchus. He was followed up with serial CT scans with the most recent scan showing right middle lobe collapse and consolidation. Thus, definitive treatment with surgery was offered. The video shows a standard 3 port VATS technique employing the Edinburgh posterior approach. The cyst was exposed, pulmonary ligament divided and the cyst was de-roofed. A large volume of turbid cystic fluid was evacuated and the middle lobe re-inflated completely at the end of the operation. In this video we offer our technique of de-roofing bronchogenic cysts and in our opinion, the posterior approach offers the best view. Furthermore, there is little evidence to suggest complete excision of a bronchogenic cyst achieves better outcomes compared to de-roofing.