This site is not optimized for Internet Explorer 8 (or older).

Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.

Step-by-Step Thoracoscopic Right Upper Lobe Posterior Segmentectomy

Monday, September 18, 2017

Martin, Jeremiah; Crist, Jonathan; Hochstetler, Marion (2017): Step-by-Step Thoracoscopic Right Upper Lobe Posterior Segmentectomy.
CTSNet, Inc.
Retrieved: 21:19, Sep 18, 2017 (GMT)

The posterior segment of the right upper lobe lends itself to a straightforward anatomic resection. Understanding the anatomy is key, and the authors present two cases that illustrate a stepwise approach.

The general steps of a posterior segmentectomy of the right upper lobe:

  1. Perform a bronchoscopy prior to the procedure to understand the segmental anatomy, as not all patients will have a typical trifurcated right upper lobe.
  2. Begin with a posterior dissection. Identify the bronchus and the take-off of the right upper lobe.
  3. Dissect the major fissure and identify the pulmonary artery. Follow this plane toward the dissection point in step 2.
  4. Complete the division of the major fissure using a stapler.
  5. Dissect vascular structures to the posterior segment. The vein is generally the first structure to present in the fissure.
  6. Dissect and divide the posterior ascending branch of the pulmonary artery.
  7. Dissect and retrieve lymph nodes during the course of the procedure to optimize the N1 yield.
  8. Inspect the bronchus and divide the appropriate posterior bronchus. Bronchoscopy can be helpful at this point.
  9. Identify the division point within the parenchyma. Traditionally, this is achieved by gentle ventilation after division of the bronchus, however this has the disadvantage of reducing working space in the chest. A more optimal solution, and one which better respects vascular supply, is some form of perfusion-based imaging.
  10. Divide the parenchyma using staples that are appropriate for thicker tissue.


Very nice video, and beautiful surgery. The part that I find the hardest is finding the correct vein branch. In this video you made it look so simple! Any tricks that you can share? Maybe my mistake is I try to trace it from the hilum, but maybe just going to the fissure and working on it there is the way to go Thank you!

Add comment

Log in or register to post comments