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| LETTER TO EDITOR |
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| Year : 2014 | Volume
: 51
| Issue : 6 | Page : 65 |
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A new technique for dissection of the vessels simultaneously
Y Xuan, Z Wang, M Wang, Y Luo, W Jiao
Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| Date of Web Publication | 24-Feb-2015 |
Correspondence Address:
Dr. W Jiao
Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266003
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-509X.151986
How to cite this article:
Xuan Y, Wang Z, Wang M, Luo Y, Jiao W. A new technique for dissection of the vessels simultaneously. Indian J Cancer 2014;51, Suppl S2:65 |
Sir,
The video-assisted thoracic surgery has been approved worldwide and becomes the regular operation procedure for most patients with early stage nonsmall cell lung cancer. [1],[2],[3],[4],[5] The conventional method of surgery has been described repeatedly. [2],[3] The vessels are ligatured separately. [5] This article describes a new technique for the dissection of the artery and vein in right upper lobectomy simultaneously.
| » Technique | |  |
Seven patients with peripheral lung cancer in right upper lobe underwent this new technique in the video-assisted right lobectomy from February 2013 to May 2013. However, other two patients with right upper lobe central cancer cannot receive this new technique.
In the video-assisted right upper lobectomy, the sheath of the superior pulmonary vein was dissected with the electrocautery hook. The entire circumstance of the vessel measured about 3 cm was separated from the tissue of hilum, exposed from the pericardium to the branches and was drawn aside with 0-0 silk to allow better viewing of the anterior trunk. The anterior trunk was divided as usual. The length measured about 3 cm of the vessel was also skeletonized for the sufficient exposure [Figure 1]a. | Figure 1: (a) The sheath of the two vessels is dissected. (b) The oval forceps are placed under the superior vein first, enlarged the space and then, (c) placed under the anterior trunk. (d) The oval forceps are removed, and the liner stapler is placed and, (e) transect the two vessels simultaneously
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The entire circumstance of the two vessels is isolated from the surrounding tissue. An oval forceps was placed beneath the two vessels through the incision on the scapular line via 7 th intercostals space. We spread the oval forceps lightly to enlarge the space between the vessels, therefore, the linear stapler can be placed easily, and the placement of the liner stapler is more fluent [Figure 1]b and c. Then the oval forceps is removed, and the linear stapler is placed to transect the two vessels simultaneously with one stapler [Figure 1]d and e.
| » Discussion | | |
The new technique for dissection of the anterior trunk and superior pulmonary vein simplifies the procedure of the video-assisted right upper lobectomy, saves the cost of the surgery. It is usually taught that one vessel matches with one-liner stapler. Two vessels need two placement of the liner stapler which may lead to other injury caused by the placement of the liner stapler. Our technique, transected the two vessels with one stapler reduced the probability of this injury, and decreased the hospital cost by one stapler.
The superior pulmonary vein lies anterior and slightly below the anterior trunk with the longitude of the two vessels is parallel, which provides operational feasibility for the new technique. We use the oval forceps to test the feasibility during the procedure for every patient with the right upper lung cancer. The circular measure of the oval forceps is similar to the endoscopic linear stapler, and meanwhile it is more dexterous and cause less damages for the tissue than the liner stapler. Once the oval forceps can be placed under the two vessels, the base plate of the liner stapler can pass underneath the two vessels easily.
However, this technique cannot be used in the cases with the central cancer and the metastasis hilar lymph node. The vessels with cancer or lymph node invasion cannot provide sufficient clearance for the placement of the liner stapler. In two patients with the vessels adhered with the cancer and lymph node, the space only let the oval forceps through. We ligatured the vessel separately with silk instead of the liner stapler.
Since February 2013, this technique has been applied in seven cases with right upper lobe cancer. No operative deaths and no complications attributed to the technique. Therefore, based on our experience, this new technique can simplify the procedure and reduce the cost without compromising the safety of the operation.
| » References | | |
| 1. | Shen JF, Zhang XX, Li SB, Guo ZH, Xu ZQ, Shi XS, et al. Complete video-assisted thoracoscopic surgery for pulmonary sequestration. J Thorac Dis 2013;5:31-5.  |
| 2. | Takeo S, Tsukamoto S, Kawano D, Katsura M. A new technique for dissection of the pulmonary vessels. Ann Thorac Surg 2011;92:1530-1. |
| 3. | Zhang Z, Huang J, Yin R, Xu L. A new technique for partial removal of the pulmonary artery in video-assisted thoracic surgical lobectomy. J Thorac Cardiovasc Surg 2012;144:512-4. |
| 4. | Jiao W, Zhao Y, Huang T, Shen Y. Two-port approach for fully thoracoscopic right upper lobe sleeve lobectomy. J Cardiothorac Surg 2013;8:99. |
| 5. | Liu C, Pu Q, Ma L, Mei J, Xiao Z, Liao H, et al. Video-assisted thoracic surgery for pulmonary sequestration compared with posterolateral thoracotomy. J Thorac Cardiovasc Surg 2013;146:557-61. |
[Figure 1]
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