Uniportal VATS Segment-6 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. A useful 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. The pleura is opened bluntly with a finger. Palpation of the thoracic wall for adhesions and insertion of a wound protection film.

Initially, the thorax is explored for macroscopically suspicious lesions and adhesions. Subsequently, the preparation of the pulmonary ligament for lung mobilization is begun. The preparation is extended cranially, paraesophageal at the dorsal hilum. During this process, the lymph nodes of stations 8 and 9 (according to IALSC = International Association for the Study of Lung Cancer) are removed.

Careful opening of the interlobar visceral pleura and exposure of the interlobar part of the pulmonary artery.

In preparation for the resection of the segmental artery A6 with the stapling device and for clear identification, the perivascular layer of the pars interlobaris of the pulmonary artery is carefully opened. The interlobar lymph nodes (station 11 according to IALSC) should be completely resected.

The segmental artery A6 is bluntly dissected and encircled using an Overholt clamp. The artery is transected using an endoscopic stapling device. It is essential to have the artery completely exposed before the stapling device is introduced, as otherwise there is an increased risk of injury and bleeding.

Note:

• For narrow-caliber vessels, in addition to adequate dissection, a "curved-tip" cartridge of the stapling device is helpful.
• Depending on the situation, the preparation and introduction of the stapling device can also be simplified by traction on the vessel.
• The vessels at the segmental level can alternatively also be securely closed with titanium clips.