CHAPTER 9 Right Middle Lobectomy—video 9
Approach to Video-Assisted Right Middle Lobectomy
Order of Operative Steps
The order of steps for the operation is as follows: RML vein, major fissure between the RML and the right lower lobe (RLL), RML bronchus, RML artery, and the minor fissure. The incisions are described in Chapter 1 (see Figure 1-2). For a right middle lobectomy, place the utility incision (i.e., incision 3) one intercostal space below the superior pulmonary vein.
Video-Assisted Right Middle Lobectomy
Step 1. Right Middle Lobe Vein
♦ Use the standard incisions, although the auscultatory incision is often not necessary (Figure 9-1). The utility incision is made directly up from the superior pulmonary vein, as for an upper lobectomy.
♦ Dissect between the inferior and superior pulmonary veins to define the inferior border of the RML vein, and determine whether there is drainage from the middle lobe to the inferior pulmonary vein.
♦ With DeBakey pickups and Metzenbaum scissors, define the superior and inferior aspect of the RML vein (Figure 9-2).
♦ With a vascular stapler from the utility incision or the auscultatory triangle incision, if used, transect the RML vein.
