Igai Hitoshi, Kamiyoshihara Mitsuhiro
Department of General Thoracic Surgery Maebashi Red Cross Hospital 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan.
Department of General Thoracic Surgery Maebashi Red Cross Hospital Japan.
Multimed Man Cardiothorac Surg. 2019 Dec 20;2019. doi: 10.1510/mmcts.2019.046.
The fissureless technique for lobectomy is considered one of the most useful and effective techniques for patients who have a fused fissure because it offers a relatively low risk of prolonged postoperative air leakage. In the fissureless technique, we use "unidirectional dissection" or "unidirectional stapling" because of the limited angle of approach necessitated by thoracoscopic surgery. Uniportal thoracoscopic surgery has even more access angle limitations than a typical multiportal approach and can be very challenging. When performing fissureless lobectomies, especially lower lobectomies, we have to insert a stapler to divide the bronchus behind which the pulmonary arteries run. It is critically important to avoid injury to the pulmonary arteries as this might cause catastrophic bleeding. We use the "suction device trick" to protect the pulmonary arteries: The suction device is inserted between the lower bronchus and the pulmonary artery, which runs behind it, when stapling, and this ensures that stapling can safely be done without any risk of injury to the pulmonary artery. In this video tutorial we demonstrate our technique for a uniportal thoracoscopic fissureless right lower lobectomy in a patient with a dense fissure, using the suction device trick, and we explain the nuances of performing it.
对于存在融合裂的患者，无裂技术肺叶切除术被认为是最有用且有效的技术之一，因为它术后长时间漏气的风险相对较低。在无裂技术中，由于胸腔镜手术所需的进路角度有限，我们采用“单向解剖”或“单向缝合”。单孔胸腔镜手术比典型的多孔入路有更多的进路角度限制，可能极具挑战性。在进行无裂肺叶切除术时，尤其是下叶切除术，我们必须插入缝合器来切断肺动脉走行后方的支气管。避免损伤肺动脉至关重要，因为这可能导致灾难性出血。我们使用“吸引器技巧”来保护肺动脉：在缝合时，将吸引器插入下支气管与走行于其后方的肺动脉之间，这确保了能够安全地进行缝合而不会有损伤肺动脉的风险。在本视频教程中，我们展示了在一名存在致密裂的患者中使用吸引器技巧进行单孔胸腔镜无裂右下叶切除术的技术，并解释了操作的细微之处。
