By Dominique Gossot
Video-assisted significant pulmonary resections are rising in popularity, because it turns into noticeable that minimally invasive surgical procedure is helpful by way of diminished postoperative ache, shorted health center remain, shorter restoration and higher compliance to adjuvant chemotherapy, with no compromising oncological rules. assorted ideas were defined, looking on the use or non-use of an adjunct mini-thoracotomy and of endoscopic instrumentation and display screen. this kind of innovations is the utterly endoscopic process. this method can end up demanding and tedious as the working mode or even the anatomical landmarks are diversified and, in many ways, need to be relearned. the aim of this atlas is to explain every one endoscopic pulmonary lobectomy and segmentectomy step-by-step, counting on short technical notes and top of the range nonetheless photographs that are oriented and labelled to cause them to as understandable as attainable. every one bankruptcy is brought through an anatomical history that is illustrated by means of three-d reconstructions. Technical «tricks» and particular hazards are pointed out through pictograms.
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Extra info for Atlas of Endoscopic Major Pulmonary Resections
41 Lobectomies Staple line Atlas of Endoscopic Major Pulmonary Resections 3. Bronchus The third stage is the exposure and control of the upper lobe bronchus. The upper lobe is pulled downward and forward so that the posterior and superior aspects of the bronchus are visualized (Fig. 9). The tissues and bronchial arteries surrounding the bronchus are freed using a diathermy hook of scissors. Peribronchial lymph nodes are removed during dissection. Traction on the lobe helps exposing the bronchus (Fig.
The sheath of the pulmonary artery is entered, seeking for the branch that arises from its anterior aspect (Fig. 2b). This branch is the lateral segmental artery. It is divided after application of clips or a vessel sealing device or a combination of both. At this stage, if is usually difficult to find the medial segmental artery, which is hidden inside a groove. It is thus preferable to first control the vein before dissecting the other elements. A apex RUL ant Lobectomies ML RLL B apex RUL ML Lateral segmental artery ant Fig.
B) Arterial supply to the upper lobe (anterior view). (c) Venous drainage (anterior view). The lower root of the SPV is the middle love vein and should be preserved. (d) Relationships between bronchi and arteries of the right upper lobe. (e) Relationships between bronchi, arteries, and veins of the right upper lobe. PA: pulmonary artery, SPV: superior pulmonary vein, dotted lines: level of division, a: artery, v: vein. 37 Atlas of Endoscopic Major Pulmonary Resections • Veins: The superior pulmonary vein is the most anterior element.