Uniportal VATS sleeve resection of the right upper lobe

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 musculature 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 exploration of the thorax and the release of minor adhesions follows. Subsequently, the exposure of the lung hilum begins with incision and blunt dissection of the pleural covering, and exposure of the anterior trunk of the right pulmonary artery and the upper pulmonary vein.

Now the partial exposure of the anterior trunk is completed and circumferentially, bluntly dissected. Subsequently, the artery can be safely transected using an endoscopic stapling device after traction.

After detaching the anterior trunk, there is now sufficient space to continue the dissection of the superior pulmonary vein. Care must be taken to observe a possible confluence of the middle lobe vein. The vein is bluntly dissected in a circular manner.

By visualizing the superior pulmonary vein, the pulmonary artery, and the entry of the middle lobe vein, the minor fissure can be transected using a stapling device, guided by these anatomical landmarks.

The upper pulmonary vein is now transected using an endoscopic stapling device after creating a sufficiently large tunnel through the completion of circular preparation and blunt dissection.

After resection of the anterior trunk, the superior pulmonary vein, and the minor fissure, the pulmonary artery can be followed from the trunk after the departure of the anterior trunk. Only after the pulmonary artery is clearly visualized can the parenchyma above the vessel trunk be bluntly elevated and transected using a stapling device. Now the view of the pars interlobaris of the pulmonary artery with the branches to segment 2, the middle lobe, segment 6, and the basal segments is revealed. The segmental artery A2 is now bluntly dissected and exposed.

Note:

• Pulling on the pulmonary artery is not strictly necessary, but in the event of a vascular injury, it can significantly minimize bleeding, allowing for vascular suturing or targeted hemostatic measures to still be possible endoscopically.