No.25-Contest2020-Uniportal VATS Left S3 & S1+2a Segmentectomy

A 67 years old male patient was suffurred from pulmonary infection 1-year ago and a GGO lesion with maximum diameter 2cm is detected in his left upper lobe. Patient recieved reexiamination 10 months after curation of infection and the lesion was considerated to be malignant. According to the CT scan and 3D-CTPA, we plan to resect left S3 and S1+2a for preserving pulmonary function and enough margin.A 3.5cm-length incision on 4th intercostal space between mid and posterior axillary line is our approch. Operation consists of three steps. 1 Managing structures of S1+2a We dissect lung hilum to expose the branches of upper lobe vein. After identifying V1+2ab,V3b+V1+2a and V3b, we ligature V3b+V1+2a,V3b and cut off them with ultrosonic scalpel. Along the V1+2ab and V1+2+V3a, A1+2a,A1+2b and V1+2a+V3b are exposed to be ligatured and cut off, after which, B1+2a is dealt with by stapler. 2 Managing structures of S3 A3b is ligatured and cut off, while B3b is dealt with by stapler. After which, A3a+A1+2c, B3a and V3a are exposed.B3a is ligtured and cut off and We preserve A1+2c while cutting off A3a, V3a. 3 Managing intersegment plane. We show the intersegment plane through expanding and collapsing lung with pure oxygen. We dissect the plane between S4 and S3 along V4 with energy instruments in order to faciliate the using of stapler. Similarly, we dissect the plane between S1+2 and S3 along A1+2c and V1+2c, after which, we remove the target segment(S1+2,S3) through stapler. The frozen section indicates adenocarcinoma and it is confimed by paraffin section which shows 1cm for invasive adenocarcinoma while AIS and AAH acount for the rest of tumor. The biopsy of No.11、12、5、7 shows negtive.

• Category: Segmentectomy,Contest 2020
• Duration: 11:02
• Date:  4 years ago
• Tags:   no-tag