By Dominique Gossot
Video-assisted significant pulmonary resections are rising in popularity, because it turns into noticeable that minimally invasive surgical procedure is helpful when it comes to lowered postoperative soreness, shorted clinic remain, shorter restoration and higher compliance to adjuvant chemotherapy, with out compromising oncological ideas. diversified thoughts were defined, reckoning on the use or non-use of an adjunct mini-thoracotomy and of endoscopic instrumentation and display screen. this kind of ideas is the definitely endoscopic procedure. this system can turn out demanding and tedious as the working mode or even the anatomical landmarks are varied and, in many ways, must be relearned. the aim of this atlas is to explain each one endoscopic pulmonary lobectomy and segmentectomy step-by-step, hoping on short technical notes and top quality nonetheless photographs that are oriented and labelled to lead them to as understandable as attainable. every one bankruptcy is brought by means of an anatomical heritage that's illustrated by means of three-d reconstructions. Technical «tricks» and particular hazards are pointed out through pictograms.
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Extra resources for Atlas of Endoscopic Major Pulmonary Resections
6 – Station 7 (left side). Final aspect after complete clearance of the subcarinal area. Care should be taken when retracting the esophagus and the left main bronchus. 26 Phrenic nerve B Vagus nerve Ligamentum arteriosum A apex Subclavian artery Phrenic nerve ant Vagus nerve 6 Aortic arch 5 Pulmonary artery 5 Fig. 7 – Stations 5 and 6. (a) General view of the subaortic window. (b) Pleural incision (dotted line). apex Aortic arch Vagus nerve ant Recurrent laryngeal nerve Fig. 8 – Stations 5 and 6.
5 – Division of the middle lobe vein gives access to the lobar bronchus.
B) Pleural incision (dotted line). 29 Atlas of Endoscopic Major Pulmonary Resections General considerations All paratracheal nodes located at the level of the middle third of the lateral aspect of the trachea (station 2R) and those located near the angle between the trachea and the main bronchus (station 4R) are removed en bloc. Dissection of 4R nodes may require to lift the azygos vein up, either with an instrument or by taping it (Fig. 13). apex Superior vena cava 2R ant 4R Fig. 12 – Stations 2R and 4R: close-up view of tiny veins arising from the superior vena cava (black arrow).