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. 2012 Oct;4(5):520-47.
doi: 10.3978/j.issn.2072-1439.2012.09.04.

Thoracoscopic anatomic pulmonary resection

Jianxing He  1 , Xin Xu
Affiliations

Thoracoscopic anatomic pulmonary resection

Jianxing He et al. J Thorac Dis. 2012 Oct.
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1
Anatomy of the right lung. (A) Frontal view of the right pulmonary lobe; (B) lateral view of the right pulmonary lobe; and (C) lateral-rear view of the right pulmonary lobe.
Figure 2
Figure 2
Anatomy of the left lung. (A) Frontal view of the left pulmonary lobe; (B) lateral view of the left pulmonary lobe; and (C) lateral-rear view of the left pulmonary lobe.
Figure 3
Figure 3
The different designs of knot pushers. 1. The knot pusher with a “C”-shaped head; 2. the knot pusher with a “Y”-shaped head; and 3. the lateral tube of a knot pusher.
Figure 4
Figure 4
The appearance of the electric hook designed by Jianxing He.
Figure 5
Figure 5
Surgical position.
Figure 6
Figure 6
The distribution of incisions in a VATS lobectomy.
Figure 7
Figure 7
The fissures of the right lobe. (A) The upper part of the right oblique fissure. The arrow crosses the gap between the recurrent branch of the right upper pulmonary artery and the dorsal segment of the right lower pulmonary artery; (B) The horizontal fissure. The arrow crosses the gap above the right middle pulmonary artery; and (C) The lower part of the right oblique fissure. The arrow crosses the gap between the right middle pulmonary artery and the basilar segment of the right lower pulmonary artery.
Figure 8
Figure 8
The fissures of the left lobe. The lower part of the left oblique fissure. The arrow crosses the gap between the lingual segment of the left upper pulmonary artery and the basilar segment of the left lower pulmonary artery.
Figure 9
Figure 9
The incision of the mediastinal pleura. (A) Phrenic nerve; (B) lung edge; (C) pulmonary artery; (D) cutting line; (E) the upper pulmonary vein; and (F) the lower pulmonary vein.
Figure 10
Figure 10
Incision of the lower pulmonary ligament.
Figure 11
Figure 11
The location of the various devices when loosening the lower pulmonary ligament.
Figure 12
Figure 12
Locating the fissure using the location of the lobar veins. A. The lower pulmonary vein; B. the middle-lobe branch of the upper pulmonary vein; and C. the upper pulmonary vein. a. the gap for the cutting of the oblique fissure and b. the gap for the cutting of the horizontal fissure.
Figure 13
Figure 13
Locating the fissure using the location of the lobar bronchus. The arrow shows the gap between the right upper lobar bronchus and the middle bronchus.
Figure 14
Figure 14
The fissure is cut with the guiding tube.
Figure 15
Figure 15
The locations of the various devices when cutting the fissure.
Figure 16
Figure 16
The edges of lung tissue are sutured with a continuous back and forth stitching using prolene thread.
Figure 17
Figure 17
The silk ligation of blood vessels using the knot pusher.
Figure 18
Figure 18
Suture of blood vessels.
Figure 19
Figure 19
Clamping blood vessels with a titanium clip.
Figure 20
Figure 20
Ligating the blood vessels using the cutting stapler. Up: direct ligation of the blood vessel and Down: ligation of the blood vessel under the guidance of the pediatric urethral catheter.
Figure 21
Figure 21
Severing of the bronchus using the cutting stapler.
Figure 22
Figure 22
Cut open the mediastinal pleura of the hilum. (A) Phrenic nerve; (B) lung edge; (C) pulmonary artery; (D) incision line; (E) upper pulmonary vein; and (F) lower pulmonary vein.
Figure 23
Figure 23
The location of the various devices. Incision A is used for thoracoscopic viewing; the ring forceps is used to lift and pull the lobe via incisions B and C; the mediastinal pleura is cut by the electric hook via incision B.
Figure 24
Figure 24
Ligating the right upper pulmonary vein using an endoscopic cutting stapler.
Figure 25
Figure 25
The apicoanterior branch of the right upper pulmonary artery is severed with an endoscopic cutting stapler.
Figure 26
Figure 26
The ascending branch of the right upper pulmonary artery is ligated with a knot pusher.
Figure 27
Figure 27
The location of various devices when the blood vessel is severed using an endoscopic cutting stapler.
Figure 28
Figure 28
Sever the right upper lobar bronchus.
Figure 29
Figure 29
The reinforcement of the bronchus stump with a continuous suture.
Figure 30
Figure 30
The location of various devices while severing the right upper lobar bronchus.
Figure 31
Figure 31
Severing of the middle vein using an endoscopic cutting stapler.
Figure 32
Figure 32
The location of the various devices.
Figure 33
Figure 33
Ligation of the right middle pulmonary artery.
Figure 34
Figure 34
Severing of the middle lobar bronchus using an endoscopic cutting stapler.
Figure 35
Figure 35
Severing of the right lower pulmonary vein using the endoscopic cutting stapler.
Figure 36
Figure 36
The location of various devices. Incision A is used for thoracoscopic viewing; the ring forceps is used to lift and pull the lobe via incisions B and C; and the endoscopic cutting stapler is used to sever the right lower pulmonary vein via incision B.
Figure 37
Figure 37
(upper right). Severing of the right lower pulmonary artery.
Figure 38
Figure 38
(left). Severing of the right lower lobar bronchus.
Figure 39
Figure 39
The locations of the various devices.
Figure 40
Figure 40
Incision of the mediastinal pleura. The dotted line indicated by the arrow is the cutting line along the pulmonary edge.
Figure 41
Figure 41
Severing of the left upper pulmonary vein using an endoscopic cutting stapler.
Figure 42
Figure 42
The location of the various devices.
Figure 43
Figure 43
Severing of each branch of the upper left pulmonary artery using an endoscopic cutting stapler.
Figure 44
Figure 44
Severing of the upper left lobar bronchus using an endoscopic cutting stapler.
Figure 45
Figure 45
After the left lower pulmonary vein is freed, it is severed using an endoscopic cutting stapler.
Figure 46
Figure 46
Severing of the left lower pulmonary artery trunk using an endoscopic cutting stapler.
Figure 47
Figure 47
Severing of the left lower lobar bronchus using an endoscopic cutting stapler.
Figure 48
Figure 48
Anatomical schematic of the bronchus and arteries of the lingual segment.
Figure 49
Figure 49
The dissection of the oblique fissure of the left lung using a cutting stapler.
Figure 50
Figure 50
The lingual segmental artery of the left upper pulmonary artery is clamped with a vascular clip and then severed.
Figure 51
Figure 51
The lingual segmental vein of the upper pulmonary vein is freed and then severed using a cutting stapler.
Figure 52
Figure 52
Severing of the lingual segmental bronchus using an endoscopic cutting stapler.
Figure 53
Figure 53
The lingual segment without inflation expansion is continuously severed using an endoscopic cutting stapler.
Figure 54
Figure 54
Patient’s position.
Figure 55
Figure 55
Cutting the mediastinal pleura.
Figure 56
Figure 56
Severing of the right lower pulmonary vein.
Figure 57
Figure 57
Severing of the right upper pulmonary vein.
Figure 58
Figure 58
Handling of the right pulmonary artery trunk. (A) A stapler is used to clamp the right pulmonary artery trunk and (B) the stapler is used to clamp the first branch of the right pulmonary artery trunk.
Figure 59
Figure 59
The clamping of the right main pulmonary bronchus with a stapler.
Figure 60
Figure 60
Cutting the hilar mediastinal pleura of the left lung.
Figure 61
Figure 61
Severing of the left lower pulmonary vein.
Figure 62
Figure 62
Severing of the left upper pulmonary vein.
Figure 63
Figure 63
Severing of the left pulmonary artery trunk.
Figure 64
Figure 64
Severing of the left main pulmonary bronchus.
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