Download PDF by Dominique Gossot: Atlas of Endoscopic Major Pulmonary Resections

By Dominique Gossot

ISBN-10: 2287997768

ISBN-13: 9782287997761

ISBN-10: 2287997776

ISBN-13: 9782287997778

Video-assisted significant pulmonary resections are becoming more popular, because it turns into noticeable that minimally invasive surgical procedure is useful by way of diminished postoperative ache, shorted sanatorium remain, shorter restoration and higher compliance to adjuvant chemotherapy, with out compromising oncological rules. diversified innovations were defined, reckoning on the use or non-use of an adjunct mini-thoracotomy and of endoscopic instrumentation and visual display unit. this sort of ideas is the definitely endoscopic technique. this method can end up tough and tedious as the working mode or even the anatomical landmarks are diversified and, in many ways, must be relearned. the aim of this atlas is to explain every one endoscopic pulmonary lobectomy and segmentectomy step-by-step, counting on short technical notes and top quality nonetheless photos that are oriented and labelled to lead them to as understandable as attainable. each one bankruptcy is brought through an anatomical heritage that's illustrated by means of three-d reconstructions. Technical «tricks» and particular hazards are pointed out by way of pictograms.

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Extra info for Atlas of Endoscopic Major Pulmonary Resections

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In order to limit the number of ports, we use either 3-mm retracting devices or throw-off retractors for the lung. Even when operating with caution, it is hard avoiding fragmenting lymph nodes. The use of atraumatic, fenestrated grasping forceps minimizes this risk. In case of hemorrhage from a broken node, hemostasis is performed by bipolar cautery. During open or video-assisted 22 General considerations II – Endoscopic mediastinal lymph node dissection lymphadenectomy, small vessels are usually controlled by a combination of clipping and transection.

Stations 6 and 5 The left upper lobe is retracted downward. The endoscope is then positioned in such a way that a bird’s-eye view on the aortopulmonary window is obtained (Fig. 7). The phrenic nerve and the vagus nerve are identified. The mediastinal pleura facing the aortopulmonary window is incised, taking care to preserve the nerves that can be difficult to visualize in some overweight patients. Pleural flaps are gently moved away, and the takeoff of the recurrent laryngeal nerve is identified.

It may be advisable to perform lymph node dissection before the pulmonary resection. Since exposure of the subcarinal region can be difficult, it is advisable to perform this step before the pulmonary resection. Indeed, the vision can be partly obscured by the stump of the left inferior pulmonary vein (in case of a lower lobectomy). In addition, this prevents the risk of tearing a vascular or a bronchial stump during lung retraction (Fig. 5). 25 Atlas of Endoscopic Major Pulmonary Resections General considerations instrument, thus exposing the subcarinal lymph nodes and/or the right main bronchus (Fig.

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Atlas of Endoscopic Major Pulmonary Resections by Dominique Gossot

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