VATS Lobectomies

This video demonstrates video-assisted thoracoscopic surgery lobectomies, providing step-by-step instructional videos that dissect important structures in a library format, organized by each specific lobe.

1. Left Upper Lobectomy

A left upper lobectomy began with the dissection of the superior pulmonary vein. A ring forceps was used to safely pass behind the pulmonary vein. A 6 mm Penrose drain was utilized to help guide the vascular staple, which was a 35 mm white vascular staple. After this, dissection over the anterior trunk was performed with a straight clamp. A Penrose drain was not used in this case because the dissection was clear. Identifying as many branches of the pulmonary artery as possible greatly facilitated the future dissection of the bronchus to the upper lobectomy.

The ring forceps were used again with the Penrose drain for the posterior ascending artery. The ring forceps allowed safe passage behind the bronchus to the upper lobe. The Penrose drain helped guide the tissue staple, and a 45 mm green staple was employed to cut the bronchus. After dividing the bronchus, there was little tissue left, so a 45 mm gold staple with multiple firings was used to complete the lobe. Care was taken to avoid impinging on the main pulmonary artery, allowing branches of the lingular artery to be cut together.

2. Left Lower Lobectomy

A left lower lobectomy began with the inferior pulmonary vein. However, this patient had many adhesions, so a Bovie was utilized to help free the right hand. A C-clamp was used to dissect behind the pulmonary vein. A 6 mm Penrose drain was employed to help guide the vascular staple, which was a 35 mm white vascular staple. After dividing the inferior pulmonary vein, attention turned to the hilum to obtain some of the fissure, which helped expose the pulmonary artery to the lower lobe. Again, the 6 mm Penrose drain was used to guide the tissue stapler. The ring forceps were used to dissect behind the pulmonary artery. In this case, the Penrose drain was not used as the dissection was well done. At this point, only the bronchus and the incomplete fissure remained. A 45 mm green staple was used to complete the lobectomy, followed by a 45 mm gold staple to secure the remaining tissue and finalize the left lower lobectomy.

3. Right Upper Lobectomy

A right upper lobectomy began with the division of the superior pulmonary vein. This was done safely using ring forceps that allowed dissection behind the pulmonary vein. A 6 mm Penrose drain was utilized to help guide the vascular staple. Subsequently, dissection was performed on the branches of the pulmonary artery to the upper lobe. In this case, the Penrose drain was not needed as the dissection was clear. A straight clamp was used to cut the remainder of the anterior trunk, with the Penrose drain again assisting in guiding the 35 mm white staple. Next, attention was directed to the fissure to help expose the posterior ascending and the bronchus to the upper lobe using gold 45 mm staples. The straight clamp was employed to dissect behind the posterior ascending artery, followed by the use of a 35 mm white staple. A 45 mm green staple was then used for the bronchus. Finally, the incomplete fissure was addressed with multiple firings of the 45 mm gold staples, completing the lobectomy.

4. Right Middle Lobectomy

A right middle lobectomy began with the dissection of the right middle lobe vein. Ring forceps were used to safely pass behind the vein. An Endo Peanut or a Bovie could help in navigating through some of the loose tissue. A 6 mm Penrose drain was used to guide the vascular staple, which was a 35 mm white staple. For the vessels, a vascular staple was employed. Subsequently, attention turned to the fissures to help expose the artery to the middle lobe and the bronchus, accomplished with 45 mm gold staples. A C-clamp was used to assist in dissecting behind the bronchus to the middle lobe. The 6 mm Penrose drain was again used to help guide the tissue staple, specifically a 45mm green staple.

Inflation was performed to ensure that the upper and lower lobes were not compromised. Once more, the ring forceps were used to safely pass behind the artery to the middle lobe safely, without the Penrose drain due to the clarity of the dissection. The lobectomy was completed using a 45 mm gold staple.

5. Right Lower Lobe

A right lower lobectomy began with the dissection of the inferior pulmonary vein, performed with a C-clamp. A 6 mm Penrose drain was used to guide the vascular staple, which was a 35 mm white vascular staple. After dissection of the inferior pulmonary vein, attention moved to the hilum to dissect the branches to the lower lobe of the pulmonary artery. A 5 mm ring forceps was used to dissect beneath the artery safely. The 6 mm Penrose drain was again used to guide the vascular staple, which was a 35 mm vascular staple. Following the dissection of the pulmonary artery branches to the lower lobe, only the bronchus and the remaining incomplete fissure were left. A 45 mm green tissue staple was used. A 45 mm gold staple was used for the remaining tissue, completing the lobectomy.

This video submission is from the 2026 CTSNet Instructional Video Competition. Stay tuned to CTSNet.org and the CTSNet YouTube channel in the coming weeks to watch all entries from the competition, including the winning videos.  

References

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