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George RAKOVICH

Maisonneuve-Rosemont Hospital, University of Montreal
Montreal, Канада
MD, FRCSC, FACS
327 лайков
10.5K просмотров
2 комментариев
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Video-assisted thoracoscopic (VATS) lobectomy: left lower lobe
Standard treatment of early-stage non-small cell lung cancer (NSCLC) involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterior lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.
Key aspects of the procedure include the following:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.
The VATS approach can be performed with lower morbidity and an equivalent or better oncologic outcome to traditional open surgery. We present a VATS lobectomy for a carcinoid tumor of the left lower lobe in a 42-year-old patient. The video lays emphasis on the steps of lobe resection; mediastinal lymph node dissection was performed but is not shown.
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens for their continued support.
Хирургические операции
4 лет назад
825 просмотров
85 лайков
0 комментариев
08:05
Video-assisted thoracoscopic (VATS) lobectomy: left lower lobe
Standard treatment of early-stage non-small cell lung cancer (NSCLC) involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterior lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.
Key aspects of the procedure include the following:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.
The VATS approach can be performed with lower morbidity and an equivalent or better oncologic outcome to traditional open surgery. We present a VATS lobectomy for a carcinoid tumor of the left lower lobe in a 42-year-old patient. The video lays emphasis on the steps of lobe resection; mediastinal lymph node dissection was performed but is not shown.
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens for their continued support.
Video-assisted thoracoscopic (VATS) lobectomy: middle lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterolateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.
Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions (Although we favor a fully thoracoscopic technique for all our cases, some centers may use a 4 to 5cm “working incision” near the axilla);
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.
The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for an adenocarcinoma of the middle lobe in a 67-year-old patient (the video emphasizes the steps of lobe resection - mediastinal lymph node dissection was effected but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their unfaltering dedication and continued support.
Хирургические операции
5 лет назад
465 просмотров
42 лайков
0 комментариев
08:49
Video-assisted thoracoscopic (VATS) lobectomy: middle lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterolateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.
Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions (Although we favor a fully thoracoscopic technique for all our cases, some centers may use a 4 to 5cm “working incision” near the axilla);
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.
The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for an adenocarcinoma of the middle lobe in a 67-year-old patient (the video emphasizes the steps of lobe resection - mediastinal lymph node dissection was effected but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their unfaltering dedication and continued support.
Technique for endoscopic resection of obstructive endobronchial malignancy
Invasion of the tracheo-bronchial tree by a malignant pulmonary lesion is the most frequent cause of bronchial obstruction in the adult. Malignant obstruction of major airways may require endoscopic resection for rapid palliation of dyspnea and obstructive pneumonitis.
Patients should be evaluated with flexible bronchoscopy and computed tomography of the chest to assess the anatomy of the obstruction and demonstrate patent airway distally. This criterion is critical for optimal selection.
Resection is carried out in the operating room under general anesthesia. It is important to emphasize that close collaboration between the surgical and anesthesia teams is essential at all times, as they are sharing responsibility for the airway. We use rigid bronchoscopy for piecemeal extraction of the lesion. Since moderate bleeding may be encountered, the clinician should be familiar with hemostatic manoeuvres including dabbing raw bronchial surfaces using the rigid bronchoscope, the use of epinephrine soaked pledgets, and irrigation using epinephrine solution. Hemostasis may also be accomplished using energy sources delivered through a flexible bronchoscope, including electrocautery, argon beam, and Nd:YAG laser. All energy sources should be used with caution within the airway to minimize the risk of complications.
Depending on the individual patient, endobronchial resection may be combined with airway stenting and/or postoperative chemoradiotherapy. In carefully selected patients, this will result in adequate palliation of symptoms.
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their continued support.
Хирургические операции
6 лет назад
846 просмотров
8 лайков
0 комментариев
04:07
Technique for endoscopic resection of obstructive endobronchial malignancy
Invasion of the tracheo-bronchial tree by a malignant pulmonary lesion is the most frequent cause of bronchial obstruction in the adult. Malignant obstruction of major airways may require endoscopic resection for rapid palliation of dyspnea and obstructive pneumonitis.
Patients should be evaluated with flexible bronchoscopy and computed tomography of the chest to assess the anatomy of the obstruction and demonstrate patent airway distally. This criterion is critical for optimal selection.
Resection is carried out in the operating room under general anesthesia. It is important to emphasize that close collaboration between the surgical and anesthesia teams is essential at all times, as they are sharing responsibility for the airway. We use rigid bronchoscopy for piecemeal extraction of the lesion. Since moderate bleeding may be encountered, the clinician should be familiar with hemostatic manoeuvres including dabbing raw bronchial surfaces using the rigid bronchoscope, the use of epinephrine soaked pledgets, and irrigation using epinephrine solution. Hemostasis may also be accomplished using energy sources delivered through a flexible bronchoscope, including electrocautery, argon beam, and Nd:YAG laser. All energy sources should be used with caution within the airway to minimize the risk of complications.
Depending on the individual patient, endobronchial resection may be combined with airway stenting and/or postoperative chemoradiotherapy. In carefully selected patients, this will result in adequate palliation of symptoms.
Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their continued support.
Video-assisted thoracoscopic (VATS) lobectomy: left upper lobe
Standard treatment of early stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterior lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.

Key aspects of the procedure include:
Proper patient positioning:
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air-leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.

The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for an adenocarcinoma of the left upper lobe in a 66-year-old patient (the video emphasizes the steps of lobe resection – complete mediastinal lymph node dissection was effected but is not shown).

Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their continued support.
Хирургические операции
6 лет назад
3411 просмотров
20 лайков
0 комментариев
10:02
Video-assisted thoracoscopic (VATS) lobectomy: left upper lobe
Standard treatment of early stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterior lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.

Key aspects of the procedure include:
Proper patient positioning:
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air-leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.

The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for an adenocarcinoma of the left upper lobe in a 66-year-old patient (the video emphasizes the steps of lobe resection – complete mediastinal lymph node dissection was effected but is not shown).

Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their continued support.
Endoscopic staple-assisted diverticulostomy in the treatment of Zenker’s diverticulum
Zenker’s diverticulum (ZD) is an acquired pulsion pouch that was first described by Ludlow in 1769. It develops within a natural anatomic dehiscence zone (Killian’s triangle), which is located between the cricopharyngeal and the inferior constrictor muscles, and is due to failure of the cricopharyngeus to relax with swallowing.
The principles of treatment include division of the obstructing cricopharyngeal muscle and adequate drainage of the pouch. This can be achieved successfully with an endoscopic per-oral technique using an endoscopic stapler, as described by Collard in 1993.
Adequate cervical extension and opening of the mouth are a prerequisite for the procedure, which is otherwise indicated for all patients having a symptomatic ZD larger than 2.0cm. Very small diverticula (< 1.0cm), make it difficult to achieve adequate exposure and a complete myotomy; in contrast, very large diverticula leave behind a residual pouch which may be responsible for postoperative dysphagia.
ESD provides short inpatient and operating times, along with a short anesthesia time (mean of 10 to 30 minutes duration). Also, it only causes a mild postoperative discomfort and the patient is able to resume a diet on the same day. It is therefore cost-effective. The most common encountered complications are chipped teeth, postoperative fever and aspiration pneumonia.
Overall, results of this technique in appropriately selected patients are excellent, with a success rate well above 90%.
Needed equipment for this procedure includes:
- Weerda’s diverticuloscope
- Endopath™ articulating endoscopic stapler ATB 45
- Standard cartridges 45mm/3.5mm
- Endo Stitch™ with 2/0 silk sutures
- Closed-end esophageal suction
- 4mm, 0-degree rigid endoscope, 30cm long
References
Ludlow A. A case of obstructed deglutition from a preternatural dilation of and bag formed in the pharynx. Medical Observations Inquiries 1769;3:85-101.
Chang CY, Payyapilli RJ, Scher RL.Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope. 2003 Jun;113(6):957-65.
Leporrier J, Salamé E, Gignoux M, Ségol P. Zenker's diverticulum: diverticulopexy versus diverticulectomy. Ann Chir. 2001 Feb;126(1):42-5.
Wasserzug O, Zikk D, Raziel A, Cavel O, Fleece D, Szold A. Endoscopically stapled diverticulostomy for Zenker's diverticulum: results of a multidisciplinary team approach. SurgEndosc. 2010 Mar;24(3):637-41. Epub 2009 Aug 18.
Feeley MA, Righi PD, Weisberger EC, Hamaker RC, Spahn TJ, Radpour S, Wynne MK.
Zenker's diverticulum: analysis of surgical complications from diverticulectomy and cricopharyngealmyotomy. Laryngoscope. 1999 Jun;109(6):858-61.
Cook RD, Huang PC, Richstmeier WJ, Scher RL.Endoscopic staple-assisted esophagodiverticulostomy: an excellent treatment of choice for Zenker's diverticulum. Laryngoscope. 2000 Dec;110(12):2020-5.
Cummings CW, Haughey BH, Thomas JR, Harker LA, Flint PW. Cummings Otolaryngology: Head and Neck Surgery. Chapter 74.
Хирургические операции
7 лет назад
1211 просмотров
5 лайков
0 комментариев
03:34
Endoscopic staple-assisted diverticulostomy in the treatment of Zenker’s diverticulum
Zenker’s diverticulum (ZD) is an acquired pulsion pouch that was first described by Ludlow in 1769. It develops within a natural anatomic dehiscence zone (Killian’s triangle), which is located between the cricopharyngeal and the inferior constrictor muscles, and is due to failure of the cricopharyngeus to relax with swallowing.
The principles of treatment include division of the obstructing cricopharyngeal muscle and adequate drainage of the pouch. This can be achieved successfully with an endoscopic per-oral technique using an endoscopic stapler, as described by Collard in 1993.
Adequate cervical extension and opening of the mouth are a prerequisite for the procedure, which is otherwise indicated for all patients having a symptomatic ZD larger than 2.0cm. Very small diverticula (< 1.0cm), make it difficult to achieve adequate exposure and a complete myotomy; in contrast, very large diverticula leave behind a residual pouch which may be responsible for postoperative dysphagia.
ESD provides short inpatient and operating times, along with a short anesthesia time (mean of 10 to 30 minutes duration). Also, it only causes a mild postoperative discomfort and the patient is able to resume a diet on the same day. It is therefore cost-effective. The most common encountered complications are chipped teeth, postoperative fever and aspiration pneumonia.
Overall, results of this technique in appropriately selected patients are excellent, with a success rate well above 90%.
Needed equipment for this procedure includes:
- Weerda’s diverticuloscope
- Endopath™ articulating endoscopic stapler ATB 45
- Standard cartridges 45mm/3.5mm
- Endo Stitch™ with 2/0 silk sutures
- Closed-end esophageal suction
- 4mm, 0-degree rigid endoscope, 30cm long
References
Ludlow A. A case of obstructed deglutition from a preternatural dilation of and bag formed in the pharynx. Medical Observations Inquiries 1769;3:85-101.
Chang CY, Payyapilli RJ, Scher RL.Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope. 2003 Jun;113(6):957-65.
Leporrier J, Salamé E, Gignoux M, Ségol P. Zenker's diverticulum: diverticulopexy versus diverticulectomy. Ann Chir. 2001 Feb;126(1):42-5.
Wasserzug O, Zikk D, Raziel A, Cavel O, Fleece D, Szold A. Endoscopically stapled diverticulostomy for Zenker's diverticulum: results of a multidisciplinary team approach. SurgEndosc. 2010 Mar;24(3):637-41. Epub 2009 Aug 18.
Feeley MA, Righi PD, Weisberger EC, Hamaker RC, Spahn TJ, Radpour S, Wynne MK.
Zenker's diverticulum: analysis of surgical complications from diverticulectomy and cricopharyngealmyotomy. Laryngoscope. 1999 Jun;109(6):858-61.
Cook RD, Huang PC, Richstmeier WJ, Scher RL.Endoscopic staple-assisted esophagodiverticulostomy: an excellent treatment of choice for Zenker's diverticulum. Laryngoscope. 2000 Dec;110(12):2020-5.
Cummings CW, Haughey BH, Thomas JR, Harker LA, Flint PW. Cummings Otolaryngology: Head and Neck Surgery. Chapter 74.
Endoscopic resection of an endobronchial hamartoma
Invasion of the tracheo-bronchial tree by a malignant pulmonary lesion is the most frequent cause of bronchial obstruction in the adult. However, benign lesions, although rare, may also occur.
Hamartoma is amongst the most frequent benign endobronchial tumors. In many cases, these tumors are amenable to endoscopic treatment (either resection or laser ablation), thus sparing the patient the potential morbidity of a thoracotomy and bronchial or parenchymal resection.
We present a case of bronchoscopic resection of a hamartoma obstructing the left lower lobe bronchus in a 58-year-old patient who had presented with cough and post-obstructive pneumonia.
Key aspects of the procedure include:
- Optimal pre-operative evaluation with flexible bronchoscopy and computed tomography of the chest.
- Close collaboration between the surgical and anesthesia teams who are sharing responsibility for the airway.
- Careful use of energy sources within the airway.
- Adequate precautions in case of an unexpected major endobronchial bleed.
The prognosis of completely resected benign tumors is excellent.
Acknowledgment: we would like to thank Nathalie Leroux RN and Mélodie Leclerc RN for their continued support.
Хирургические операции
7 лет назад
1409 просмотров
12 лайков
0 комментариев
03:33
Endoscopic resection of an endobronchial hamartoma
Invasion of the tracheo-bronchial tree by a malignant pulmonary lesion is the most frequent cause of bronchial obstruction in the adult. However, benign lesions, although rare, may also occur.
Hamartoma is amongst the most frequent benign endobronchial tumors. In many cases, these tumors are amenable to endoscopic treatment (either resection or laser ablation), thus sparing the patient the potential morbidity of a thoracotomy and bronchial or parenchymal resection.
We present a case of bronchoscopic resection of a hamartoma obstructing the left lower lobe bronchus in a 58-year-old patient who had presented with cough and post-obstructive pneumonia.
Key aspects of the procedure include:
- Optimal pre-operative evaluation with flexible bronchoscopy and computed tomography of the chest.
- Close collaboration between the surgical and anesthesia teams who are sharing responsibility for the airway.
- Careful use of energy sources within the airway.
- Adequate precautions in case of an unexpected major endobronchial bleed.
The prognosis of completely resected benign tumors is excellent.
Acknowledgment: we would like to thank Nathalie Leroux RN and Mélodie Leclerc RN for their continued support.
Completely thoracoscopic segmentectomy: apical segment, right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. In patients with compromised lung function, anatomic segmentectomy may be an acceptable alternative to lobectomy. Traditionally, this procedure has been carried out via postero-lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with disturbed respiratory mechanics in the postoperative period, as well as chronic postoperative pain which may become incapacitating in 5% of patients.
One of the major potential advantages of thoracoscopic approaches is decreasing the incidence of post-thoracotomy pain.
Key aspects of thoracoscopic segmentectomy include:
Proper patient positioning.
Access to the pleural cavity and appropriate positioning of operating incisions.
Careful dissection of segmental branches of the pulmonary artery and bronchus.
Division of blood vessels and bronchus using endoscopic staplers.
Division of lung parenchyma along intersegmental planes.

The thoracoscopic approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present a completely thoracoscopic resection of the apical segment of the right upper lobe for a small T1 adenocarcinoma in a 78-year-old patient. The video emphasizes the steps of segmental resection —mediastinal lymph node dissection was effected but is not shown.

Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support. Additionally, the figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
Хирургические операции
8 лет назад
637 просмотров
22 лайков
0 комментариев
09:44
Completely thoracoscopic segmentectomy: apical segment, right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. In patients with compromised lung function, anatomic segmentectomy may be an acceptable alternative to lobectomy. Traditionally, this procedure has been carried out via postero-lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with disturbed respiratory mechanics in the postoperative period, as well as chronic postoperative pain which may become incapacitating in 5% of patients.
One of the major potential advantages of thoracoscopic approaches is decreasing the incidence of post-thoracotomy pain.
Key aspects of thoracoscopic segmentectomy include:
Proper patient positioning.
Access to the pleural cavity and appropriate positioning of operating incisions.
Careful dissection of segmental branches of the pulmonary artery and bronchus.
Division of blood vessels and bronchus using endoscopic staplers.
Division of lung parenchyma along intersegmental planes.

The thoracoscopic approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present a completely thoracoscopic resection of the apical segment of the right upper lobe for a small T1 adenocarcinoma in a 78-year-old patient. The video emphasizes the steps of segmental resection —mediastinal lymph node dissection was effected but is not shown.

Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support. Additionally, the figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
Video-assisted thoracoscopic (VATS) lobectomy: right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via posterolateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.

One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.

Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.

The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for neuro-endocrine carcinoma of the right upper lobe in a 71-year-old patient (the video emphasizes the steps of lobe resection —mediastinal lymph node dissection was effected, but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support.
*The figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
Хирургические операции
8 лет назад
737 просмотров
93 лайков
0 комментариев
08:01
Video-assisted thoracoscopic (VATS) lobectomy: right upper lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via posterolateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.

One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.

Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.

The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for neuro-endocrine carcinoma of the right upper lobe in a 71-year-old patient (the video emphasizes the steps of lobe resection —mediastinal lymph node dissection was effected, but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Martin RN, and Mélodie Leclerc RN for their continued support.
*The figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
Video-assisted thoracoscopic (VATS) lobectomy: right lower lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via postero-lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.
Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air-leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.
The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for adenocarcinoma of the right lower lobe in a 78-year-old patient (the video emphasizes the steps of lobe resection - mediastinal lymph node dissection was effected but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Girard RN, and Mélodie Leclerc RN for their continued support.

*The figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.
Хирургические операции
8 лет назад
939 просмотров
40 лайков
0 комментариев
09:56
Video-assisted thoracoscopic (VATS) lobectomy: right lower lobe
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via postero-lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients.
One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain.
Key aspects of the procedure include:
- proper patient positioning;
- access to the pleural cavity and appropriate positioning of operating incisions*;
- careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air-leaks;
- division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers.
The VATS approach can be carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for adenocarcinoma of the right lower lobe in a 78-year-old patient (the video emphasizes the steps of lobe resection - mediastinal lymph node dissection was effected but is not shown).
Acknowledgment: we would like to thank Nathalie Leroux RN, Francine Girard RN, and Mélodie Leclerc RN for their continued support.

*The figure used to illustrate the positioning of operating incisions was adapted with permission from: «Handbook of perioperative care in general thoracic surgery», Deslauriers J, Mehran R, eds. Positioning and incisions, pages 206-227, fig 5-19, Copyright Elsevier, 2005.