title: Unidirectionally progressive left pneumonectomy & mediastinal lymph node dissection.
abstract: The patient has lower left lung tumor and adenocarcinoma at the openings of both upper and lower left lung. Preoperative bronchoscopic biopsy has confirmed the diagnosis. The surgical approach is unidirectionally progressive left pneumonectomy + mediastinal lymph node dissection. The layers of structure are treated one after another until the fissure from a single direction through the working port. Hence, the resecting order should be left superior pulmonary vein-left lower pulmonary vein-left main bronchus-left pulmonary artery. The vessels and bronchi are cut using an endoscopic linear stapler or the Hemolock clips. The resected lobe is placed into a large-size specimen bag 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. 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. Similar to traditional resection of left lung lobes, 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.
authors.affiliation: Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Kaican
authors.initials: K
authors.lastname: Cai
authors.affiliation: Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Ren
authors.affiliation: Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Siyang
authors.initials: S
authors.lastname: Feng
authors.affiliation: Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Haofei
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Xiong
authors.affiliation: Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Ziliang
authors.initials: Z
authors.lastname: Zhang
keywords: Thoracoscopic operation; left pneumonectomy; unidirectionally progressive