Steven Rothenberg, MD
steverberg@aol.com
#thoracoscopy #children's lung surgery #lobectomy
Steven Rothenberg, MD; Rocky Mountain Hospital for Children
This video demonstrates the technique for an anatomic segmental resection of the lingula in a 4 kg 3 month old infant. A CPAM was diagnosed on prenatal ultrasound at 26 weeks and measured 2.2x2.8x3.5 cm. Repeat US at 36 weeks showed the size to be 3.9x2.6x3.8. The baby was delivered at 36 weeks and was asymptomatic. A CT scan at 3 months of age showed a CPAM that appeared to be limited to the lingula. The infant was taken to the OR and a anatomic lingulectomy was planned using 3 ports (4,3,5mm). An anatomic segmental resection was performed. The surgery took 90 minutes and a chest drain was left overnight and removed the following morning. The infant was discharged on the second post-operative day without complication. Anatomic segmentectomy is feasible and safe and may be appropriate in some cases of CPAM as a lung sparing alternative.
Intended audience: Healthcare professionals and clinicians.
A CPAP was diagnosed by prenatal ultrasound at 26 weeks. An MRI at 29 weeks confirmed this, and a repeat ultrasound at 36 weeks showed an enlarging CPAP. The CT scan at 3 months of age showed persistence of the CPAM in the lingula, and a thochoscopic resection was planned. Upon going into the left chest, an incomplete fissure was found. The fissure was developed using the 3 millimeter vessel sealer. Here you can see the fissure being opened layer by layer to expose the pulmonary vasculature going to both the lower lobe and. The lingula. Care is taken to not compromise any of the vascular structures going to the lower lobe. Although the fissure is quite incomplete, it can be taken in a systematic fashion. With minimal blood loss. And no injury to the surrounding structures. Once the fissure is opened, the. Pulmonary vein to the lingula is identified, isolated. And then sealed and divided. The 3 millimeter vessel sealer is used to take the vessels, with two separate seals being placed at least 3 to 4 millimeters apart, and then the vessel being divided between the seals. Partial division is accomplished first to ensure that the seals are intact, and once the lumin is seen, then the division is completed. With the lingular vein taken. Dissection is continued posterior to expose the lingular artery and the bronchus to the lingula. A mental resection of the lingula. Is accomplished fairly easily once all of these structures are taken. One can still see the hyperinflation of the lingula even though the rest of the lung is collapsed because of the right main stem innovation. In this case, the bronchus to the regula lies on top of the artery. The bronchus, because of its small size, is taken with a singular 5 millimeter clip. The bronchus is divided, and then the ringular artery is identified, and this is sealed proximally and discally and divided as with the vein. This completed, a line of demarcation begins to be seen between the lingula and the rest of the upper lobe. There's another small. Branch of the artery which is identified, sealed, and divided. Now, the hyperinflated lingula can still be seen, but the demarcation between the lingula and the upper lobe becomes quite clear. Separation between the lingula and the superior segment of the upper lobe is started with the 3 millimeter sealer. And then once the plane is clearly seen, the 5 millimeter stapler is used to complete the segmental reception. 3 applications of the 5 millimeter. Stapler are used to completely divide the lingula from the remnant of the upper lobe. This is then brought out through the lower troke website. The area is checked for an air leak. Here you can see the. Lower lobe and upper lobe clearly inflating. And no air leak is present. Small. Bronchiol is identified with the posterior aspect of the deception. And this is sealed with a single 5 millimeter clip. Chest was removed on postoperative day one, and the patient was discharged at home.
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