Lingulectomy—Video 17

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CHAPTER 17 Lingulectomy—Video 17

Robert J. McKenna, Jr.

Introduction

The anatomy of the lingua is consistent, and this operation is usually straightforward.

Approach to Video-Assisted Lingulectomy

Order of Operative Steps

The order of the steps for a lingulectomy is as follows: level 5 and 6 nodes, lingular vein, fissure, lingular artery, bronchus, and fissure.

Key Points

♦ A minimal fissure often can be identified between the lingula and upper division.
♦ Work from anterior to posterior.
♦ Rarely, the lingular veins can drain to both the superior pulmonary vein and the inferior pulmonary vein.

image Video-Assisted Lingulectomy (Video 17)

Step 1. Incisions

♦ The standard incisions shown in Chapter 1 are used (see Figure 1-2).

Step 2. Resection of Level 5 and 6 Nodes

♦ The nodes are resected as for a left upper lobectomy (see Figure 11-1 in Chapter 11). This helps to define the anatomy of the superior pulmonary vein and branches.
♦ Rarely, the lingula may drain to the superior and inferior pulmonary veins.

Step 3. Lingular Vein

♦ Exposure: Retract the lung posteriorly through the posterior incision.
♦ Aim the thoracoscope slightly anteromedially, and point the lens slightly posteriorly.
♦ Look at the fissure and the superior pulmonary vein to identify the vein that drains the lingula.
♦ Through incision 3, dissect the vein from the lingula with DeBakey pickups and Metzenbaum scissors (Figure 17-1). Through the anterior incision, pass the right-angle clamp behind the vein, and spread it widely (Figure 17-2).
♦ Place clips through the anterior incision onto the lingular vein. Alternatively, staple the vein, but clips usually suffice because it is small (Figure 17-3).
image

Figure 17-1 Superior vein, upper division vein, and lingular vein.

image

Figure 17-2 The right-angle clamp passes around the lingular vein.

image

Figure 17-3 The stapler is positioned across the lingular vein.

Step 4. Complete the Fissure

♦ Exposure: Return the lung to its normal anatomic position. Through the posterior incision, retract the lower lobe posteriorly and inferiorly. Through the utility incision, retract the upper lobe anteriorly and superiorly.
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