Sleeve Lobectomy: Right Upper Lobe

Published on 13/02/2015 by admin

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Last modified 13/02/2015

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CHAPTER 13 Sleeve Lobectomy

Right Upper Lobe – Video 13

Robert J. McKenna, Jr.

Introduction

Surgeons with excellent video skills can perform a standard sleeve lobectomy as video-assisted thoracic surgery (VATS). The initial steps for a right upper lobe (RUL) sleeve lobectomy are the same as for a standard right upper lobectomy.

Approach to Video-Assisted Sleeve Lobectomy of the Right Upper Lobe

Order of Operative Steps

The order of the steps of the operation is as follows: level 10 nodes, RUL vein, anterior trunk of the artery, minor fissure, posterior ascending artery, and the fissure. The mainstem and the intermediate bronchi are then cut. The bronchial anastomosis is made through the utility incision with standard thoracotomy instruments. The standard incisions are used, with the utility incision placed directly up (lateral) from the superior pulmonary vein.

Key Points

♦ Use the standard approach for a right upper lobectomy initially.
♦ The right upper lobe bronchus is posterior to the right pulmonary artery and must be separated from the artery for transection.
♦ Mediastinoscopy with a complete subcarinal node dissection mobilizes the mainstem and intermediate bronchi from the lymph nodes and pericardium. Perform the mediastinoscopy during the same anesthesia as the sleeve lobectomy because a delay between the two procedures produces adhesions that make the dissection more difficult.
♦ At the junction of the cartilage and membranous portion of the intermediate bronchus, place a stay suture posteriorly to help appose the intermediate and mainstem bronchi.
♦ Place the posterior row of sutures first.

image Video-Assisted Sleeve Lobectomy of the Right Upper Lobe (Video 13)

Step 1. Initial Procedures

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