Totally endoscopic right apico-posterior segmentectomy for stage I lung carcinoma

This is the case of a 56-year-old male patient presenting with stage I (cT1N0) adenocarcinoma of the posterior segment of the right upper pulmonary lobe. In this case, we will perform a totally endoscopic segmentectomy, namely only video display and endoscopic instrumentation without utility incision. A 3cm incision is made at completion of the segmentectomy by enlarging one of the ports for specimen extraction. In this video, only the main steps of the pulmonary resection will be demonstrated. The lymphadenectomy will be shown in another video. 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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Totally endoscopic right apico-posterior segmentectomy for stage I lung carcinoma

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Abstract

This is the case of a 56-year-old male patient presenting with stage I (cT1N0) adenocarcinoma of the posterior segment of the right upper pulmonary lobe.
In this case, we will perform a totally endoscopic segmentectomy, namely only video display and endoscopic instrumentation without utility incision. A 3cm incision is made at completion of the segmentectomy by enlarging one of the ports for specimen extraction.
In this video, only the main steps of the pulmonary resection will be demonstrated. The lymphadenectomy will be shown in another video.

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

Classification

basic techniques

Keywords

Totally endoscopic right apico-posterior segmentectomy, stage I lung carcinoma

Media type

Surgical video

Duration

05'06''

Publication

2009-02

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E-publication

WeBSurg.com, Feb 2009;9(02).
URL: http://www.websurg.com/doi-vd01en2522.htm

Totally endoscopic right apico-posterior segmentectomy for stage I lung carcinoma

1. Clinical case presentation 00'12''

This is the case of a 56-year-old male patient presenting with stage I (cT1N0) adenocarcinoma of the posterior segment of the right upper pulmonary lobe. In this case, we will perform a totally endoscopic segmentectomy, namely only video display and endoscopic instrumentation without utility incision. The patient is placed in a left lateral decubitus position.

2. Patient and trocars position 00'32''

Four ports are used. One 10mm optical port for the endoscope is placed in the 6th intercostal space in the mid-axillary line. Two working ports are utilized: one 5mm port in the 6th intercostal space on the posterior axillary line, and one 15mm port in the 6th intercostal space on the anterior axillary line, that will be enlarged at the end of the procedure for specimen retrieval. Finally, a 4th 3mm port is placed in the 4th intercostal space on the anterior axillary line and it will accommodate the retractor.

3. Posterior segmental artery dissection and division 01'26''

Once the posterior portion of the main fissure has been divided as for an upper lobectomy, the posterior segmental artery is dissected. Since it is rather a big artery, a clip is applied before application of bipolar thermal fusion.

4. Lobar bronchus exposure 02'12''

The upper lobe is tracted upward and forward in order to expose the lobar bronchus. A 3mm grasping forceps helps to expose the 3 branches of the bronchus. The segmental branches are carefully dissected keeping in mind the presence of an apical artery on the opposite side. The upper aspect of the lobar bronchus is freed from its attachments to the upper lobe. A loop is passed around the 2 segmental branches using blunt tip deflectable retractor.

5. Bronchus segmental branches division 03'31''

The 2 segmental branches are stapled. A posterior segmental artery is then discovered. It is dissected and divided after clipping. Exposure of the vein is achieved by pulling the upper lobe backward. The apical segmental vein is exposed by simple pledget dissection. It is then dissected and clipped. Finally, the parenchyma can be divided. A clamp is applied under gentle reventilation in order to identify the border between the posterior and apical segments and the anterior segment. The specimen has been placed into an Endobag and retrieved through one of the ports that has been enlarged and the lung is being re-ventilated.