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. 2018 Sep;6(18):365.
doi: 10.21037/atm.2018.09.21.

Troubleshooting complicated hilar anatomy via prophylactically clamping the pulmonary artery: three videos demonstrating three techniques

Chengwu Liu  1   2 , Lin Ma  1   2 , Qiang Pu  1   2 , Jiandong Mei  1   2 , Hu Liao  1   2 , Yunke Zhu  1   2 , Feng Lin  1   2 , Lunxu Liu  1   2
Affiliations

Troubleshooting complicated hilar anatomy via prophylactically clamping the pulmonary artery: three videos demonstrating three techniques

Chengwu Liu et al. Ann Transl Med. 2018 Sep.

Abstract

Complicated hilar anatomy (i.e., tumor invasion, lymphadenopathy, calcification, carbonization, and dense inflammatory adhesions) is technically challenging and often leads to catastrophic intraoperative complications and conversion to open thoracotomy during video-assisted thoracic surgery (VATS) lobectomy. The technique of prophylactically clamping the pulmonary artery (PA) has been reported to be effective in troubleshooting complicated hilar anatomy. However, there are no records on details regarding techniques to treat different hilar complication situations. In this paper, we will introduce three techniques, namely suture ligation, endo-stapler angioplasty, and suture angioplasty, for dealing with different kinds of complicated hili during VATS lobectomy through three video demonstrations.

Keywords: Video-assisted thoracic surgery (VATS); complicated hilum; lobectomy; pulmonary artery (PA); troubleshooting.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Suture ligation. The video depicts a three-portal thoracoscopic right upper lobectomy. There were dense inflammatory adhesions and severe lymphadenopathy between the bronchus and the pulmonary artery. The arterial branches were sutured and divided after prophylactically clamping the pulmonary artery (10). Available online: http://www.asvide.com/article/view/27375
Figure 2
Figure 2
Endo-stapler angioplasty. The video depicts a three-portal thoracoscopic left upper lobectomy. There were dense adhesions and severe lymphadenopathy around the first arterial branch. Angioplasty was performed using endo-stapler after prophylactically clamping the pulmonary artery (12). Available online: http://www.asvide.com/article/view/27376
Figure 3
Figure 3
Suture angioplasty. The video depicts a three-portal thoracoscopic left upper lobectomy. The left pulmonary artery trunk was partially involved by the lesion. Angioplasty with partial removal of the pulmonary artery using continuous suture was performed after clamping both of the proximal and distal trunks of the pulmonary artery (13). Available online: http://www.asvide.com/article/view/27377
See this image and copyright information in PMC

Comment in

  • Prevention is better than cure!
    Lorusso M, De Palma A, De Iaco G, Marulli G. Lorusso M, et al. Ann Transl Med. 2019 Jan;7(1):25. doi: 10.21037/atm.2018.12.18. Ann Transl Med. 2019. PMID: 30788372 Free PMC article. No abstract available.
  • Troubleshooting in advanced VATS procedures.
    Uzunel A, Petersen RH. Uzunel A, et al. Ann Transl Med. 2019 Jun;7(11):248. doi: 10.21037/atm.2019.05.39. Ann Transl Med. 2019. PMID: 31317018 Free PMC article. No abstract available.

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