CHAPTER 18 Superior Segmentectomy—Video 18
Introduction
The approach to a superior segmentectomy varies with the completeness of the fissure. If the fissure is complete, I prefer an anterior approach because the artery can be easily visualized in the fissure. If the fissure is incomplete, the entire fissure can be completed (as for a lower lobectomy [see Chapter 11]) so the anterior to posterior approach can be performed. Alternatively, the segmentectomy can be approached posteriorly.
Anterior Approach for Superior Segmentectomy (Video 18)
Step 1. Identifying the Artery in a Major Fissure: Complete Fissure
• Elevate the lower lobe with a ring forceps introduced posteriorly, and elevate the middle lobe or upper lobe (or both) with a ring forceps introduced anteriorly. If the fissure is complete, open the pleura with Metzenbaum scissors or electrocautery through the anterior incision to identify the artery (Figure 18-1).
• Through the lower anterior incision, dissect on the surface of the artery with Metzenbaum scissors. This creates a tunnel for the stapler to complete the fissure (Figure 18-2).
• Place the anvil of the stapler on the surface of the artery; it is not moved because ring forceps anteriorly and posteriorly pull the lung parenchyma of the fissure into the stapler.
• Directly below the fissure, continue to dissect with the Metzenbaum scissors beyond the superior segmental artery (Figure 18-4). The bronchus can be felt with the scissors. Continue this dissection through the posterior pleura to complete the remainder of the fissure.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
