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 decreased postoperative discomfort, shorted medical institution remain, shorter restoration and higher compliance to adjuvant chemotherapy, with no compromising oncological rules. varied recommendations were defined, reckoning on the use or non-use of an adjunct mini-thoracotomy and of endoscopic instrumentation and display screen. this sort of strategies is the utterly endoscopic process. this method can end up difficult 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 each one endoscopic pulmonary lobectomy and segmentectomy step-by-step, counting on short technical notes and high quality nonetheless images 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 via third-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
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. 10). t an ex ap RUL bronchus Intermediate bronchus Lobectomies Fig. 9 – The upper lobe bronchus. A B C Traction on the lobe helps exposing the Encircling the upper lobe bronchus Stapling the upper lobe bronchus at its bronchus. with a blunt tip deflectable retractor. origin. Fig.
Anatomical landmarks (Fig. 1) • Bronchus: The middle lobe bronchus lies in a groove between the two segmental arteries. It gives two segmental bronchi that are usually not seen during a middle lobectomy. It is advisable to first control the medial artery to open the space and facilitate the access to the lobar bronchus. • Arteries: There are usually two arteries arising separately from the pul- Lobectomies monary artery in the fissure: the lateral segmental artery whose origin is just below the confluence of the oblique and transverse fissures, opposite to the superior segmental artery, and the medial artery, which lies deeper and is hidden by the lobar bronchus.
3 – Station 10: example of peribronchial node at the origin of the right upper lobe bronchus. Stations 9 and 8 Dissection of the lymph nodes in the pulmonary ligament (station 9) is usually straightforward. It is started from the diaphragmatic attachment of the pulmonary ligament and continued upward with the dissection of the paraesophageal nodes (station 8) (Fig. 4). , the esophagus and the inferior pulmonary vein. Thus, cautious dissection and the use of bipolar diathermy are recommended. Station 7 (left-side approach) As for open surgery, the difficulties faced during the dissection of station 7 from the left side are variable.