Uniportal VATS Segment-1 Resection right with ICG

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.

First, the secure identification and palpation of the tumor are performed. Then, the area of the tumor site is marked with a thread to always assess the location of the tumor and the distance to the planned resection area during the course of the operation.

Here begins the preparation by incisions of the pleural covering at the hilum and exposure of the anterior trunk of the pulmonary artery. The anterior trunk typically contains the arterial blood supply for segments S1 and S3.

Tip: In the anatomical resection of a lung lobe or segment, the sequence of surgical steps is variable depending on the intraoperative situation.

In the area of the lung hilum, only a partial visualization of the upper pulmonary vein is performed. Subsequently, it is followed into the periphery until a clear identification of a V1 segment branch is achieved. This is then circumferentially dissected, secured with titanium clips, and transected with the ultrasonic shears.

The segmental artery A1 is circumferentially bluntly dissected. Due to the relatively large caliber, it is secured with 3 titanium clips, two proximally and one distally, before the vessel is then transected with the ultrasonic scissors.