Right middle lobectomy

Right middle lobectomy is mainly performed based on the lesions in the right lobe of the lung. The main steps are to open the chest cavity, pull the middle lobe forward appropriately, and then find the aorta and remove it according to the condition. In addition, there are right upper lobectomy, right lower lobectomy, left upper lobectomy, left lower lobectomy, etc. The clinical surgical rate is also very high.

1. Steps of right middle lobectomy

1. Open the lower half of the horizontal fissure and the oblique fissure, and pull the middle lobe forward. The middle lobe artery can be found deep in the intersection of the two pulmonary fissures. There are usually 2 branches, which are cut off after ligation.

3. Dissect out the middle lobe bronchus, ligate or suture it at the root and then cut it off.

2. Steps of right upper lobectomy

1. Pull the upper lobe back, open the mediastinal pleura, and expose the upper lobe hilar vessels. First, free the apical branch and anterior branch of the pulmonary artery, and ligate and cut them separately. The apical, anterior, and posterior branches of the superior pulmonary vein are then treated.

2. Open the upper part of the horizontal and oblique fissures. The posterior branch of the superior lobe artery can be found deep in the intersection of the two pulmonary fissures and can be ligated and cut off.

3. Free the upper lobe bronchus, sew the traction line, cut off the bronchus, and suture the stump.

3. Steps of right lower lobectomy

1. Open the oblique fissure, pull the lower lobe backwards, and pull the middle and upper lobes forwards to expose the inferior lobe artery. Because the dorsal segmental artery and the middle lobe artery often arise from the right pulmonary artery trunk at the same level, the dorsal segmental artery is ligated and cut off first, and then the basal artery is processed.

2. Pull the lower lobe forward, ligate and cut the inferior pulmonary ligament. The mediastinal pleura was pushed aside, the inferior pulmonary vein was freed, ligated with a suture, and then cut off.

3. Free the lower lobe bronchus. First cut and suture the dorsal bronchus, and then deal with the basal bronchus.

4. Steps of left upper lobectomy

1. Open the oblique fissure, pull the lower lobe backwards and the upper lobe forwards to expose the left pulmonary artery trunk. The inner side of the trunk, from top to bottom, includes the apical posterior segmental artery, the anterior segmental artery, the superior lingual segmental artery, and the inferior lingual segmental artery. There are usually 4-6 branches of the upper lobe artery. After identification, ligation and cutting are carried out.

2. Pull the upper lobe of the lung backwards to expose the superior pulmonary vein, ligate it and then cut it off.

3. Free the upper lobe bronchus, sew the traction line, cut off the bronchus, and suture the stump.

5. Steps of Left Lower Lobectomy

1. Open the oblique fissure, pull the lower lobe backwards and the upper lobe forwards to expose the inferior lobe artery. Because the superior (dorsal) segmental artery and the lingual segmental artery often arise from the left pulmonary artery trunk at the same level, the superior segmental artery is ligated and cut first.

2. Free the basilar artery from below the inferior lingual artery, ligate it, suture it, and then cut it off.

3. Pull the lower lobe forward, ligate and cut the inferior pulmonary ligament. The mediastinal pleura was pushed aside, the inferior pulmonary vein was freed, ligated with a suture, and then cut off.

4. Free the lower lobe bronchus, first cut and suture the dorsal bronchus, and then deal with the basal bronchus.