Lingulectomy—Video 17

CHAPTER 17 Lingulectomy—Video 17



Robert J. McKenna, Jr.



Introduction


The anatomy of the lingua is consistent, and this operation is usually straightforward.



Approach to Video-Assisted Lingulectomy



Order of Operative Steps


The order of the steps for a lingulectomy is as follows: level 5 and 6 nodes, lingular vein, fissure, lingular artery, bronchus, and fissure.



Key Points



♦ A minimal fissure often can be identified between the lingula and upper division.

♦ Work from anterior to posterior.

♦ Rarely, the lingular veins can drain to both the superior pulmonary vein and the inferior pulmonary vein.


image Video-Assisted Lingulectomy (Video 17)



Step 1. Incisions



♦ The standard incisions shown in Chapter 1 are used (see Figure 1-2).


Step 2. Resection of Level 5 and 6 Nodes



♦ The nodes are resected as for a left upper lobectomy (see Figure 11-1 in Chapter 11). This helps to define the anatomy of the superior pulmonary vein and branches.

♦ Rarely, the lingula may drain to the superior and inferior pulmonary veins.


Step 3. Lingular Vein



♦ Exposure: Retract the lung posteriorly through the posterior incision.

♦ Aim the thoracoscope slightly anteromedially, and point the lens slightly posteriorly.

♦ Look at the fissure and the superior pulmonary vein to identify the vein that drains the lingula.

♦ Through incision 3, dissect the vein from the lingula with DeBakey pickups and Metzenbaum scissors (Figure 17-1). Through the anterior incision, pass the right-angle clamp behind the vein, and spread it widely (Figure 17-2).

♦ Place clips through the anterior incision onto the lingular vein. Alternatively, staple the vein, but clips usually suffice because it is small (Figure 17-3).

image

Figure 17-1 Superior vein, upper division vein, and lingular vein.


image

Figure 17-2 The right-angle clamp passes around the lingular vein.


image

Figure 17-3 The stapler is positioned across the lingular vein.



Step 4. Complete the Fissure



♦ Exposure: Return the lung to its normal anatomic position. Through the posterior incision, retract the lower lobe posteriorly and inferiorly. Through the utility incision, retract the upper lobe anteriorly and superiorly.

Related posts:

  1. Thoracoscopic Sympathectomy
  2. Diaphragmatic Plication—Video 32
  3. Left Upper Lobe Apical Trisegmentectomy—Video 16-1
  4. Pneumonectomy—Video 7

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Jun 4, 2016 | Posted by in CARDIAC SURGERY | Comments Off on Lingulectomy—Video 17

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