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Thoracoscopic Middle Lobectomy
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In this segment, we look at the anatomical landmarks.
Keywords
- Middle lobectomy
- hilum
- middle lobe artery
- bronchus
- major fissure
- pulmonary vein
About this video
- Author(s)
- Dominique Gossot
- First online
- 22 September 2019
- DOI
- https://doi.org/10.1007/978-3-030-32896-2_1
- Online ISBN
- 978-3-030-32896-2
- Publisher
- Springer, Cham
- Copyright information
- © The Author(s) 2019
Video Transcript
Middle lobectomy is the only one who is started by an initial control of the vein in the hilum. It facilitates provision of the dissection in the following order, vein, bronchus, and arteries– a few variations of the middle lobe bronchus, which is usually single and faces the B6 bronchus.
The arteries can have two different patterns– a single and large artery that immediately splits into two branches, or two independent arteries for segments 4 and 5. The origin of the middle lobe artery can be close to the raise of an ascending artery for segment 3 as shown on this modelization, or on this operative view.
The vein can be single or double. In this case, it is of utmost importance not to confuse the upper middle lobe vein, which is a branch draining the upper lobe. In rare cases, the middle lobe vein can drain into the inferior pulmonary vein as shown on these two pictures.
The anterior portion of the major fissure can be thin, and it is then divided with a vessel sealing device. Or thick, and in this case, it must be stapled.