Uniportal wedge resection and pleurectomy

Incision of approximately 4 cm in length in the area of the anterior axillary line at the upper edge of the 5th rib to access the 4th intercostal space above. A helpful orientation is often an imaginary line from the tip of the scapula to the nipple. Transection of the subcutis on the rib with the monopolar knife. Subsequently, stepwise preparation of the intercostal muscles with the monopolar knife.

Now the parietal pleura is bluntly dissected from the chest wall and the access to the thoracic cavity is prepared extrapleurally. By blunt dissection, the parietal pleura can be circumferentially detached from the pleural dome.

Continue the circular preparation of the parietal pleura. To avoid unnecessary risk, the pleural covering of the major vessels and nerves should be considered the margin of the preparation. For better clarity and to safely identify these boundaries, the pleura can be incised and resected in several parts with endoscopic scissors.

This shows a typical bulla in the area of the lung apex. The lung apex is resected with a small safety margin to the bulla to avoid postoperative fistulas and leaks.

Note:

• Even if no blebs or bullae can be demonstrated intraoperatively at the lung apex or the apical area of segment 6, a so-called "blind resection" of the lung apex should be performed, as this has been shown in studies to be a positive factor in terms of recurrence rate.