Right Upper Lobe Anterior Segmentectomy—Video 19

Published on 13/02/2015 by admin

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CHAPTER 19 Right Upper Lobe Anterior Segmentectomy—Video 19

Robert J. McKenna, Jr.

Introduction

This segmentectomy is infrequently performed. Many surgeons do not know how to perform it, but it is a straightforward procedure.

Approach to Video-Assisted Right Upper Lobe Anterior Segmentectomy

Order of Operative Steps

The order of the steps of the operation is as follows: minor fissure, anterior segment vein, anterior segmental artery, segmental bronchus, and the fissure.

Key Points

♦ Work anteriorly to posteriorly, with little manipulation of the lung.
♦ No posterior dissection is necessary. Very little lung manipulation is needed.

image Video-Assisted Right Upper Lobe Anterior Segmentectomy (Video 19)

Step 1. Incisions

♦ Use the standard incisions, with the utility incision placed directly up (lateral) from the superior pulmonary vein (see Figure 1-2 in Chapter 1).

Step 2. Minor Fissure

♦ Exposure: Retract the lung posteriorly and slightly inferiorly.
♦ Aim the thoracoscope anteriorly, and point the 30-degree lens posteriorly, but it is pulled back almost to the trocar.
♦ The landmarks for completion of the minor fissure are the junction of the minor and major fissures for the staple cartridge and at the confluence of the right upper lobe and right middle lobe veins for the anvil of the stapler.
♦ Point the anvil of the stapler toward that venous confluence. Do not move the stapler. With ring forceps, pull the lung parenchyma into the jaws of the 4.8-mm endoscopic stapler pointed toward the fissure. The first firing of the stapler usually completes about one half of the fissure.
♦ With the Metzenbaum scissors through the utility incision, dissect along the inferior aspect of the right upper lobe vein to expose the pulmonary artery that lies posterior and perpendicular to the vein. Dissect the surface of the artery.
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