PMC6383419_01
(a) Chest C-T scan delineates the right lung middle lobe with a solid GGO measuring 1.5 cm in size. (b) Dorsal decubitus patient position with 40  angle during subcostal approach for right middle lobe lung lobectomy. (c) Subcostal oblique incision (5 cm) parallel to right costal arc and covidien wound protector with arrangement of instruments through the port.
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He was referred from the lung cancer screening program as the high-resolution chest computed tomography (CT) scan delineated a 1.5 cm mixed ground glass opacity (GGO) with a larger solid component in the right middle lobe (RML) (Figure 1(a)). The patient was given general anesthesia with double lumen endotracheal intubation and placed in a lateral decubitus position (dorsal decubitus 40 degrees) (Figure 1(b)). Lastly, covidien wound protector (WPLGR914) was placed (Figure 1(c)).
(a) Long curved instruments were recommended to use in subcostal approach. (b) First postoperative day in an obese class II patient with chest tube inserting through subcostal wound. (c) 5 cm subcostal incision after removing chest tube.
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Also, curved tip stapler technology aids to allow passage around the vascular structures (Figure 2(a)). After completing the procedure, a 28 F chest tube (Figure 2(b)) was inserted through the same subcostal wound. The patient was discharged on the third postoperative day with an uneventful recovery (Figure 2(c)).