title: Unidirectionally progressive resection of lower right lung cancer under video-assisted thoracoscopy.
abstract: The surgery is performed under general anesthesia with double-lumen endotracheal intubation. The patient is placed in a 90-degree position lying on the unaffected side. An approximately 1.5-cm observation port is created in the 7th intercostal space between the middle and anterior axillary lines, an approximately 4-cm working port in the 4th intercostal space between the anterior axillary line and the midclavicular line, and an approximately 1.5-cm auxiliary port in the 9th intercostal space between the posterior axillary line and the subscapular line. The operator stands in front of the patient, manipulating the endoscopic instruments while watching the monitor.
  
  
  METHODS
  since the patient has right lower lung cancer, a unidirectional procedure is adopted for the surgery, in which the layers of structure are treated one after another until the fissure from a single direction through the working port. Hence, the pulmonary vein, bronchi, pulmonary artery and the poorly developed fissure of the right lower lobe are treated successively during lobectomy. The vessels, bronchi and fissures are cut using an endoscopic linear stapler or the Hemolock clips. The resected lobe is placed into a size 8 sterile glove and retrieved through the working port to prevent contamination of the chest incision by any tumor tissue. Mediastinal lymph node dissection is performed at the end.
authors.affiliation: Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Kaican
authors.initials: K
authors.lastname: Cai
authors.forename: Hua
authors.initials: H
authors.lastname: Wu
authors.forename: Pengfei
authors.initials: P
authors.lastname: Ren
authors.forename: Ruijun
authors.initials: R
authors.lastname: Cai
authors.forename: Gang
authors.initials: G
authors.lastname: Xiong
authors.forename: Haofei
authors.initials: H
authors.lastname: Wang
keywords: Lung cancer; pulmonary lobectomy; thoracoscopic operation
references.citation: J Clin Oncol. 2009 May 20;27(15):2553-62
references.pmid: 19289625
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