Name:
Giulianotti: Video 18A-2. Operative Technique of a Robotic Left Upper Lobectomy. Six Steps Standardized Technique
Description:
Giulianotti: Video 18A-2. Operative Technique of a Robotic Left Upper Lobectomy. Six Steps Standardized Technique
Thumbnail URL:
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Duration:
T00H04M17S
Embed URL:
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Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/f38e6044-cb01-4f62-8215-180ca31a5265/Giulianotti- 18A.a2. Left Upper Technique in a Robotic Left .mp4?sv=2019-02-02&sr=c&sig=LYTerVHwB9yBsEZPcgvOxbby82aAvVN8LGvQSKhbI80%3D&st=2025-10-21T19%3A25%3A37Z&se=2025-10-21T21%3A30%3A37Z&sp=r
Upload Date:
2024-02-08T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
We now describe the step-by-step-operative technique in robotic left upper lobectomy. First of all, we use the tip-up grasper to retract the upper lobe posteriorly and expose the hilum. Now the mediastinal pleura is opened so that the lymph nodes of station 5 can be identified, dissected, and removed.
This will lead to the exposure of the superior pulmonary vein. The lingular branch should be identified and the tissue surrounding the vein should be carefully dissected using both blunt and sharp dissection to expose the vessel and safely surround it. We can now insert the vascular endostapler through port number 3 and section the vein. It is always necessary to identify the confluence of the lingular vein in the main branch, as rarely the lingular vein could confluate in the lower lobe vein.
Next step of the procedure is the preparation of the left upper pulmonary artery first branch. Once the vein is divided, usually the pulmonary artery anterior trunk becomes easily identifiable. Its division as first step facilitates the isolation and division of the upper lobe bronchus. Often the removal of a hilar lymph node located at the arterial origin facilitates its isolation. We can now identify the upper lobar bronchus that arises vertically from the main bronchus.
To better surround this structure, the lymph node that lies between the bronchus and the artery should be removed. We can now insert the stapler and after checking the re-expansion of the lower lobe, section the upper lobar bronchus. We can now proceed with the preparation of the remaining arterial branches to the upper lobe. Intervening hilar lymph nodes should be removed to facilitate the isolation of the vessels.
After pulling the lobe posteriorly, the lingular artery and the two posterior ascending branches are isolated and dissected using both sharp and blunt dissection. The lingular artery is usually resected first, after identification of the artery at fissural level. [unintelligible] branches are approached afterwards. They are isolated, surrounded with a vessel loop and sectioned.
The branches of the pulmonary artery for the left upper lobe are extremely variable both in number and course. As we saw in the present case, we found five arterial tributaries to the upper lobe.
In this case, the final step of the lobectomy is the completion of the fissure with a [unintelligible] and a stapler. As our final step, we complete the radical mediastinal lymphadenectomy approaching the subcarinal area. The mediastinal pleura is dissected from the superior edge of the lower lobe vein, all the way up along the course of the vagus nerve. Station 7 lymph nodes can now be removed.
We recommend to place a hemostatic material in the subcarinal [unintelligible] to reduce possible post-surgical bleeding and lymphatic leakage. The resected lobe is positioned inside the specimen bag and retrieved out of the utility incision.
