3-Port VATS Lobectomy Lower Lobe Left

Anatomical landmarks serve as orientation. The dashed line describes the course of the latissimus dorsi muscle. The 5th rib is usually located on an imaginary line between the scapula tip and the nipple. In the 4th intercostal space above, a 5 cm minithoracotomy is performed with the insertion of a wound protection retractor. Subsequently, under camera view, the incisions for the additional trocars can be made in the area of the 7th or 8th intercostal space ventrally and dorsally.

Note:

• With atraumatic technique and in skilled hands, it may also be advantageous to first make the caudal incision. After camera exploration through the caudal access, the placement of the minithoracotomy as a working access can be optimally adapted to the anatomical conditions.

Repositioning the camera into the ventral incision. Initiation of preparation by incising the visceral pleura in the area of the fissure. Since the interlobar part of the pulmonary artery cannot be immediately visualized, the operation continues with the preparation of the medial lung hilum and visualization of the inferior pulmonary vein.

Note:

• The sequence of preparation of the pulmonary ligament, lung hilum, and fissure is variable according to the anatomical conditions and the experience of the respective surgeon.