Thoracoscopic Upper Lobectomies for Symptomatic Congenital Pulmonary Airway...

Pulmonary upper lobectomies are more technically challenging than lower lobectomies, especially following infection.

A dual-lumen endotracheal tube and low flow chest insufflation were used to collapse the left lung during left upper lobectomy.

The fissure is completed by dividing the pulmonary tissue starting anteriorly and proceeding posteriorly.

Not dividing the superior pulmonary vein initially allows further cephalad retraction of the upper lobe.

A combination of clips and ligature is used to divide the segmental arteries.

Where distance allows, segmental vessels are clipped proximally prior to division with ligature.

10 millimeter clips are used to control each venous tributary separately when managing the superior pulmonary vein.

The segmental bronchus to the lingular segments is divided with an endo-GIA stapler.

The inferior pulmonary ligament is divided to allow the lower lobe to rise in the chest after upper lobectomy.

Left main-stem intubation was used to isolate the right lung during right upper lobectomy.

Segmental arteries are much smaller in younger children and can be taken with ligature after deliberate dissection.

The superior pulmonary vein is located in a slightly more superficial plane than the arteries.

A recurrent segmental artery to the upper lobe can arise from the main pulmonary trunk and is found in the fissure.

Both patients had excellent outcomes with complete expansion of the operated lung postoperatively.