Uniportal VATS Segment-9+10 Resection 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 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.

Initially, the exploration of the thorax is performed for macroscopically suspicious lesions and adhesions. Subsequently, the preparation begins at the interlobium. Due to the well-developed fissure, the interlobar part of the pulmonary artery with the underlying bronchial system is clearly visible after incision of the visceral pleura. Then, the lymph nodes of station 11 (according to IALSC) are removed.

After displaying the pulmonary artery, the pulmonary ligament is now prepared. Simultaneously, the lymph nodes of station 9 (according to IALSC) are removed. The preparation concludes with the display of the inferior pulmonary vein.

Continue the dissection cranially with incision of the pleural hilum at the medial lung hilum. Here, the lymph nodes of station 8 (according to IALSC) and, after precise dissection, the lymph nodes of station 7 (according to IALSC) are removed as an en-bloc resection.

By mostly blunt dissection of the lung parenchyma and situational use of the ultrasonic shears for hemostasis, the inferior pulmonary vein with the branches of the segmental veins V10 to V6 can be exposed.

Note:

• The course of the segmental veins can vary.

Analogous to the vein, the basal part of the pulmonary artery can also be further dissected in the fissure. Through blunt dissection and situational use of the ultrasonic scissors, the clear identification of the common arterial trunks of the segmental arteries A7 + A8 and A9 + A10 is achieved.

After previously displaying the segment veins at length in step 5 and preparing the arterial segment branches, the resection phase now begins. The two segment veins are each secured with titanium clips, double proximally and single distally, and then transected with the ultrasonic scissors.