CHAPTER 18 Superior Segmentectomy—Video 18
Introduction
The approach to a superior segmentectomy varies with the completeness of the fissure. If the fissure is complete, I prefer an anterior approach because the artery can be easily visualized in the fissure. If the fissure is incomplete, the entire fissure can be completed (as for a lower lobectomy [see Chapter 11]) so the anterior to posterior approach can be performed. Alternatively, the segmentectomy can be approached posteriorly.
Anterior Approach for Superior Segmentectomy (Video 18)
Step 1. Identifying the Artery in a Major Fissure: Complete Fissure
• Elevate the lower lobe with a ring forceps introduced posteriorly, and elevate the middle lobe or upper lobe (or both) with a ring forceps introduced anteriorly. If the fissure is complete, open the pleura with Metzenbaum scissors or electrocautery through the anterior incision to identify the artery (Figure 18-1).
• Through the lower anterior incision, dissect on the surface of the artery with Metzenbaum scissors. This creates a tunnel for the stapler to complete the fissure (Figure 18-2).
• Place the anvil of the stapler on the surface of the artery; it is not moved because ring forceps anteriorly and posteriorly pull the lung parenchyma of the fissure into the stapler.
• Directly below the fissure, continue to dissect with the Metzenbaum scissors beyond the superior segmental artery (Figure 18-4). The bronchus can be felt with the scissors. Continue this dissection through the posterior pleura to complete the remainder of the fissure.
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