Thoracoscopic Upper Lobectomies for Symptomatic Congenital Pulmonary Airway...

Pulmonary upper lobectomies are more technically challenging than lower lobectomies, especially following infection.

A dual lumen endotracheal tube and low flow chest insufflation were used to collapse the left lung.

Inflammatory adhesions can be seen between the left upper lobe and the chest wall.

The fissure is completed by dividing the pulmonary tissue starting anteriorly and proceeding posteriorly.

The superior pulmonary vein is identified but not divided initially to allow further cephalad retraction of the upper lobe.

A combination of clips and ligature is used to divide the segmental arteries.

Where distance allows, the segmental vessels are clipped proximally prior to division with the ligature.

10 millimeter clips are used to control each venous tributary separately.

The inferior pulmonary ligament is divided to allow the lower lobe to rise in the chest.

Left main stem intubation was used to isolate the right lung.

The arteries are much smaller in this younger child and can be taken with a ligature after deliberate dissection.

The superior pulmonary vein is identified in a slightly more superficial plane than the arteries.

The recurrent segmental artery to the upper lobe arising from the main pulmonary trunk is found in the fissure.

Both patients had excellent outcomes with complete expansion of the operated lung postoperatively.