By Dominique Gossot
Video-assisted significant pulmonary resections are rising in popularity, because it turns into seen that minimally invasive surgical procedure is useful by way of lowered postoperative ache, shorted medical institution remain, shorter restoration and higher compliance to adjuvant chemotherapy, with no compromising oncological rules. diversified strategies were defined, reckoning on the use or non-use of an adjunct mini-thoracotomy and of endoscopic instrumentation and monitor. the sort of concepts is the definitely endoscopic method. this method can turn out difficult and tedious as the working mode or even the anatomical landmarks are various and, in many ways, need to be relearned. the aim of this atlas is to explain every one endoscopic pulmonary lobectomy and segmentectomy step-by-step, counting on short technical notes and top of the range nonetheless images that are oriented and labelled to lead them to as understandable as attainable. each one bankruptcy is brought through an anatomical history that is illustrated via 3-dimensional reconstructions. Technical «tricks» and particular hazards are pointed out through pictograms.
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Extra resources for Atlas of Endoscopic Major Pulmonary Resections
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. 10 – Control of the upper lobe bronchus. Dissection of the anterior aspect of the bronchus must be conducted cautiously and flush against the bronchus wall, especially if the apical and anterior segmental arteries have not yet been stapled.
The extent of lymphadenectomy is still a controversial issue. Many different types of lymph node dissections are found in the literature, ranging from mere sampling to extended lymphadenectomy. : for right-sided tumors, removal of all lymphatic tissue bounded by the right upper bronchus, the right subclavian artery, the superior vena cava, and the trachea (stations 2R and 4R); for left-sided tumors, removal of all lymphatic tissues bounded by the phrenic nerve, the vagus nerve, and the top of the aortic arch (stations 5 and 6); and for both sides, removal of lymph nodes from stations 7 to 11.
The mediastinal pleura is incised horizontally on either side of the azygos arch so that the latter can be lifted up if necessary. Division of the azygos vein is seldom needed in patients operated on for a clinical stage 1 tumor, in whom nodes are usually not enlarged and not invaded. Incision of the mediastinal pleura is then continued so that a square pleural flap is designed. Its limits are: inferiorly, the azygos arch; superiorly, the lowest visible part of the subclavian artery; anteriorly, the posterior aspect of the superior vena cava; posteriorly, the posterior aspect of the trachea.
Atlas of Endoscopic Major Pulmonary Resections by Dominique Gossot