Dr. Rene Petersen presents the main steps and technical aspects of thoracoscopic middle lobectomy using an anterior approach.
VATS sleeve lobectomies are still a challenging procedure and are not mastered by many teams. Professor Sanghoon Jheon provides an excellent overview of this technique with amazing pictures.
Торакоскопическая сегментэктомия S9+10 левого легкого по поводу опухоли по типу "матового стекла"
Right upper lobectomy: how I do it?
The anterior approach to right upper lobectomies is the most standard one, although it is not always the easiest one. As stressed by Dr. Baste, anterior dissection of the hilum can be hazardous and requires attention. Based on demonstrative pictures and videos, Dr. Baste outlines the global preoperative and intraoperative approach used routinely at Rouen’s Teaching Hospital. The description of the technique is mainly inspired from the Danish team (Hansen et al., Surgical Endoscopy). Surgical safety is one of the key objectives of this approach with preventative methods and intraoperative management techniques in case of injury. Preoperatively, CT-scan analysis is highlighted and patient set-up is described.
The intraoperative step is also described meticulously, and notably the D-zone, which represents the most dangerous zone during the resection.
Whatever the approach, most surgeons perform an anterior dissection of hilar structures during a right upper lobectomy. Here, Dr. Gossot shows that a right upper lobectomy can be performed with a fissure-based technique and a full posterior dissection, with initial opening of the posterior fissure, followed by the division of the ascending A2 artery, then stapling of the bronchus, division of the branches of the truncus anterior, and finally of the upper root of the superior pulmonary vein.