Uniportal VATS Segment-2 Resection right

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. As a guide, an imaginary line from the tip of the scapula to the nipple is often helpful. Transection of the subcutis on the rib with the monopolar knife. Subsequently, stepwise preparation of the intercostal muscles with the monopolar knife. The pleura is opened bluntly with a finger. Palpation of the thoracic wall for adhesions and insertion of a wound protection film.

First, the thorax is explored for macroscopically suspicious lesions and adhesions. Subsequently, the interlobar part of the right pulmonary artery is exposed. By incising the visceral pleura and careful blunt dissection, a small section of the pulmonary artery can be exposed as a starting point.

Note:

• The expression of the lobe fissure is very individually variable. In the case of an incomplete fissure, dissection can begin along the hilar anatomical structures.
• Additional isolation of the endoscopic instruments can protect against contact current.

Starting from the already depicted section of the pulmonary artery, the interlobar visceral pleura can now be carefully opened, allowing for the complete visualization of the interlobar part of the pulmonary artery and its branching vessels. In this example, an atypical segment 2 vein is also presented. The segment vein V2 exhibits many variations, most commonly a central part of V2 between the segmental bronchi B2 and B3, which merges with a superficial interlobar vein.

The segmental artery A2 extends as an isolated branch from the pulmonary artery to segment 2. This is first clearly identified. Subsequently, blunt dissection of the perivascular layer is performed by circular exposure and careful maneuvering. Transection with the endoscopic stapling device.

Note:

• For narrow-caliber vessels, in addition to adequate dissection, a "Curved-Tip" magazine of the stapling device is helpful.
• Occasionally, traction on the vessel for preparation and insertion of the stapling device can facilitate the maneuver.