Thoracic surgeons who prefer an artery-first approach to VATS lobectomy generally find an incomplete fissure between the two lobes difficult to handle. It is also more difficult to perform a VATS left upper lobectomy, because there are more branches of the left upper pulmonary artery. If the surgeon dissects the hilar tissue from the anterior toward the posterior, or first dissects the vein and then the artery or bronchus, the surgeon can avoid the incomplete lung fissure problem, which makes the VATS approach much easier. Performing this procedure requires that the surgeon understand the hilar anatomy from different perspectives.
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ligasure to segmental pulmonary artery vessels ! impressive, I must try that myself. I didn’t think it would work for them.
Many Thanks
Many thanks to Dr. Qaun and to the Editor for another extremely useful video. I have two questions:
1. After closing the stapler on the upper bronchus, do you routinely inflate the left lung to confirm the lower bronchus is free?
2. What lymph nodes do you routinely take?
Best Regards
Aristotle
segmental pulmonary artery vessels are small, ligating the small artery are easy and safe.
After closing the stapler on the upper bronchus, we will routinely inflate the left lung to confirm the lower bronchus is free. the procedure is the same with open surgery. the lymph nodes we take include 5,6,7 9, L4. sometime L4 is difficult.
Many thanks again Dr. Quan