Full thoracoscopic lingulectomy

This video illustrates the case of a 54-year-old female patient presenting with a 2cm tumor of the lingula. Percutaneous biopsy under CT-scan guidance revealed a carcinoid tumor. Imaging and DOPA PET scan did not demonstrate any other localization of the disease. The patient was treated with a lingulectomy and lymphadenectomy performed via a totally endoscopic approach. The specimen was retrieved through one of the port that was enlarged at the end of the procedure. She was discharged 4 days later. Pathological examination confirmed the carcinoid tumor. All 18 removed lymph nodes were benign. This technique is presented in the book : D. Gossot Atlas of endoscopic major pulmonary resections (2010) Springer-Verlag France www.springer.com/978-2-287-99776-1

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Full thoracoscopic lingulectomy

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Abstract

This video illustrates the case of a 54-year-old female patient presenting with a 2cm tumor of the lingula. Percutaneous biopsy under CT-scan guidance revealed a carcinoid tumor. Imaging and DOPA PET scan did not demonstrate any other localization of the disease.

The patient was treated with a lingulectomy and lymphadenectomy performed via a totally endoscopic approach. The specimen was retrieved through one of the port that was enlarged at the end of the procedure. She was discharged 4 days later. Pathological examination confirmed the carcinoid tumor. All 18 removed lymph nodes were benign.

This technique is presented in the book :
D. Gossot Atlas of endoscopic major pulmonary resections
(2010) Springer-Verlag France
www.springer.com/978-2-287-99776-1

Keywords

lingulectomy, thoracoscopy

Media type

Surgical video

Duration

04'00''

Publication

2008-01

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E-publication

WeBSurg.com, Jan 2008;8(01).
URL: http://www.websurg.com/doi-vd01en2266.htm

Full thoracoscopic lingulectomy

1. Case history 00'16''

The video will demonstrate the resection of a tumor located in the left upper lobe of the lung. The operation shown is a lingulectomy, that is the excision of the lingular portion of the left upper lobe of the lung. This procedure is performed totally via thoracoscopy.

2. Operation commencement 00'37''

Here we only present the technique of the segmentectomy itself. The lymph node dissection technique will be demonstrated in another video. The fissure between the upper lobe and the lower lobe is opened with a scissors. The scissural lymph nodes are dissected.

3. Dissection of pulmonary arterial supply 00'59''

The pulmonary arterial branches afferent to the lingular artery are dissected. The lingular artery is first taped and then divided after clipping.

4. Division of lingular artery 01'47''

5. Stapling of anterior portion of fissure 02'08''

The anterior portion of the fissure is stapled and divided. The inferior root of the superior pulmonary vein is then dissected. Its small size makes it easier to divide this vessel using ultrasonic scissors. A tape is placed around the lingular bronchus.

6. Confirmation of culmen ventilation 02'58''

A re-ventilation test is carried out after this is used to occlude the lingular bronchus. This test confirms that the culmen is normally ventilated whereas the lingula is excluded from ventilation.

7. Bronchial stapling for lingulectomy 03'29''

It is often difficult to pass the stapler and a guide is therefore used to help pass it. For this we use a small aspiration tube slid posterior to the bronchus. The stapler can then be passed in a tension-free fashion posterior to the bronchus which is then divided. A clamp is applied on the parenchyma to assess the limit between culmen and lingula after re-ventilation.

8. Parenchymal stapling 04'30''

The parenchyma can then be stapled.

9. Removal of specimen 04'50''

The specimen is placed in an endoscopic bag which is extracted after enlargement of one of the port sites.