Uniportal VATS Lobectomy Middle 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 subcutis 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.

With a well-developed fissure, dissection can begin in the interlobar region. Here, superficial layers of the visceral pleura are dissected, and the pulmonary artery in the interlobar region is exposed primarily through blunt dissection.

After visualizing the pulmonary artery, the parenchymal bridges can be gradually dissected. It is essential to always expose and bluntly dissect the interlobar part of the pulmonary artery before the tissue above can be transected. This allows the pulmonary artery to be visualized over a longer section, and the vascular branches and the middle lobe artery can be better identified.

Note:

• In this operation, an arteriovenous malformation with an atypical segment 2 vein is observed, which will be removed as a segment resection in the further course of the operation.