By Dominique Gossot
Video-assisted significant pulmonary resections are becoming more popular, because it turns into noticeable that minimally invasive surgical procedure is helpful by way of decreased postoperative ache, shorted health facility remain, shorter restoration and higher compliance to adjuvant chemotherapy, with no compromising oncological ideas. assorted suggestions were defined, looking on the use or non-use of an adjunct mini-thoracotomy and of endoscopic instrumentation and monitor. this type of innovations is the utterly endoscopic procedure. this method can turn out hard and tedious as the working mode or even the anatomical landmarks are assorted and, in many ways, must 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 photos that are oriented and labelled to cause them to as understandable as attainable. each one bankruptcy is brought via an anatomical history that is illustrated by way of 3-dimensional reconstructions. Technical «tricks» and particular hazards are pointed out through pictograms.
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Extra info for Atlas of Endoscopic Major Pulmonary Resections
Division of the pulmonary ligament The pulmonary ligament is divided up to the inferior pulmonary vein using both diathermy and gentle traction on the lower lobe (Fig. 12). apex Esophagus ant Pulmonary ligament Inferior vena cava Lobectomies Fig. 12 – Division of the pulmonary ligament. In some slim patients, the pulmonary ligament can be thin and short so that the inferior pulmonary vein is reached more rapidly than expected. Diathermy must be used with caution. 6. Securing the middle lobe When the minor fissure is complete, the middle lobe must be repositioned and secured to the lower lobe.
Htm 32 Lobectomies III – Right upper lobe V – Right lower lobe VI – Left upper lobe VII – Left lower lobe Lobectomies IV – Middle lobe Right upper lobe 35 Lobectomies Chapter III Atlas of Endoscopic Major Pulmonary Resections Chapter III Right upper lobe Lobectomies The right upper lobectomy is a difficult endoscopic procedure. Difficulties are from several orders. The operative field is large, and the scope has to switch from the anterior to the posterior mediastinum and from the apex to the diaphragm.
10 – Station 7 (right side). Final aspect after complete clearance of the subcarinal area. 28 General considerations II – Endoscopic mediastinal lymph node dissection Stations 4R and 2R Even after completion of a right upper lobectomy, the paratracheal region can be obscured by the lung, which must be retracted downward. The endoscope is positioned in such a way that a bird’s-eye view on all the area located above the azygos arch is obtained (Fig. 11) since a tangential vision can lead to difficult understanding of the anatomy.