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. 2012 Nov;1(4):523-31.
doi: 10.3978/j.issn.2225-319X.2012.11.13.

Extrapleural pneumonectomy and extended pleurectomy/decortication for malignant pleural mesothelioma: the Memorial Sloan-Kettering Cancer Center approach

Valerie W Rusch  1
Affiliations

Extrapleural pneumonectomy and extended pleurectomy/decortication for malignant pleural mesothelioma: the Memorial Sloan-Kettering Cancer Center approach

Valerie W Rusch. Ann Cardiothorac Surg. 2012 Nov.
No abstract available

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Figures

Figure 1
Figure 1
Line of incision (extended posterolateral thoracotomy incision)
Figure 2
Figure 2
Extra-pleural plane developed using blunt dissection with the palm facing upwards against the ribs in a side-to-side sweeping motion
Figure 3
Figure 3
Before the chest retractor is inserted, the pleura is mobilized away from the chest wall to the apex of the chest superiorly, to the sternum anteriorly, to the spine posteriorly and to the diaphragm inferiorly
Figure 4
Figure 4
The mediastinal pleural tumor is mobilized away from the underlying mediastinal structures exposing the main bronchus and hilar vessels
Figure 5
Figure 5
Resection of diaphragmatic pleura with diaphragm muscle fibers
Figure 6
Figure 6
For right-sided resections, it is important to identify the phrenic veins draining from the diaphragm directly into the inferior vena cava
Figure 7
Figure 7
If pericardial resection is required, this is done after the pleural tumor has otherwise been completed in order to minimize intraoperative hemodynamic changes. Traction sutures are placed on the pericardium, as the resection is performed to prevent it from retracting towards the contralateral hemithorax
Figure 8
Figure 8
Lung and tumor block retracted anteriorly and right main bronchus divided with a stapler
Figure 9
Figure 9
Inferior and superior pulmonary veins are sequentially divided with a stapler
Figure 10
Figure 10
Main pulmonary artery divided with a stapler
Figure 11
Figure 11
Illustration showing Gore-tex graft for diaphragm reconstruction in position
Figure 12
Figure 12
Pericardium resection reconstructed with absorbable mesh
See this image and copyright information in PMC

References

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