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Video-assisted thoracic lobectomy with control of the main pulmonary artery
Mitsuhiro Kamiyoshihara1, Toshiteru Nagashima1, Hitoshi igai1, Yoichi Ohtaki1, Jun Atsumi2, Takashi Ibe2, Seiichi Kakegawa2, Kai Obayashi2, Masayuki Sugano2, Tetsuhiro Nakano2, Osamu Kawashima2, Kimihiro Shimizu2, Izumi Takeyoshi2.
1Maebashi Red Cross Hospital, Maebashi, Japan, 2Gunma University School of Medicine, Maebashi, Japan.
OBJECTIVE: Cross-clamping the main pulmonary artery (PA) is a risky, stressful procedure for the general thoracic surgeon performing video-assisted thoracic major pulmonary resection (VATS). However, converting a VATS to a thoracotomy each time PA clamping is planned is a poor tactic. We present a VATS technique that is simpler than the traditional method involving a thoracotomy.
METHODS: For VATS, a working port measuring less than 8 cm in length was made in the fourth or fifth intercostal space. One or two additional 1.2-cm thoracic ports were made in the seventh or ninth intercostal space. No patient required segmental rib resection or rib spreading. Two DeBakey vascular clamps with double-angle jaws were inserted through other 1-cm access incisions. We clamped the main PA to maintain the limited visual field through the working port. Therefore, we modified the position of these vascular clamps, which we call “the outside-field vascular clamping technique.”
RESULTS: We performed this procedure in tweleve patients. In both cases, we performed an arterioplasty with a left upper lobectomy under outside-field vascular clamping. Their postoperative courses were uneventful.
CONCLUSIONS: We believe that this approach can be applied to a wide range of surgical procedures, including not only control of the main PA but also bronchoplasty and completion pneumonectomy.
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