Uniportal VATS pneumonectomy right

Incision of approximately 4 cm in length in the area of the anterior axillary line at the upper edge of the 5th rib to access the 4th intercostal space above. A helpful orientation is often an imaginary line from the tip of the scapula to the nipple. Transection of the subcutaneous tissue on the rib with the monopolar knife. Subsequently, stepwise preparation of the intercostal muscles with the monopolar knife. The pleura is opened bluntly with a finger. Palpation of the thoracic wall for adhesions and insertion of a wound protection film.

First, the lung is luxated dorsolaterally, providing a view of the azygos vein. This is then freed from the pleural covering using an electric hook, bluntly dissected circularly, secured with titanium clips, and sharply transected.

Note:

• The resection of the azygos vein can be performed using clips, hand sutures, or a stapling device. Its transection facilitates the subsequent dissection and closure of the right main bronchus, although it is not mandatory.

After opening the mediastinal pleura, an incision with an electrocautery hook and blunt dissection of the mediastinal adipose tissue exposes the view of the lung hilum. Here, the anterior trunk of the central pulmonary artery is directly visible and is circumferentially dissected. The upper pulmonary vein is also clearly recognizable.

After circular presentation and blunt dissection of the anterior trunk, it can be safely transected using an endoscopic stapling device.

Note:

• The separate resection of the anterior trunk is often not possible with more central tumors, but as in this case, it facilitates the resection of the central pulmonary artery.