Dominique Gossot, MD The Annals of Thoracic Surgery

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Technical Tricks to Facilitate Totally Endoscopic Major Pulmonary Resections Dominique Gossot, MD The Annals of Thoracic Surgery Volume 86, Issue 1, Pages 323-326 (July 2008) DOI: 10.1016/j.athoracsur.2008.01.091 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Example of the limitation of a direct viewing endoscope (0°) during the division of the fissure during thoracoscopic right upper lobectomy. (A) With a 0° scope, the tip of the endostapler is out of the vision field, (B) although it can be perfectly controlled with a deflectable scope. The Annals of Thoracic Surgery 2008 86, 323-326DOI: (10.1016/j.athoracsur.2008.01.091) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 High definition deflectable tip thoracoscope allows performing the whole procedure with a single endoscope and avoids the problems related to tangential vision. The Annals of Thoracic Surgery 2008 86, 323-326DOI: (10.1016/j.athoracsur.2008.01.091) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Opening the fissure during a thoracoscopic middle lobectomy using 3-mm grasping forceps for better exposure. (ML = middle lobe; RLL = right lower lobe; RUL = right upper lobe.) The Annals of Thoracic Surgery 2008 86, 323-326DOI: (10.1016/j.athoracsur.2008.01.091) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Control of the lobar bronchus during a thoracoscopic right upper lobectomy using deflectable grasping forceps to help pass around the bronchus. (RLL = right lower lobe; RUL = right upper lobe.) The Annals of Thoracic Surgery 2008 86, 323-326DOI: (10.1016/j.athoracsur.2008.01.091) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Clamping the parenchyma to determine the intersegmental plane is achieved with a dedicated endoscopic 5-mm clamp (in this case, during a thoracoscopic lingulectomy for carcinoid tumor). The Annals of Thoracic Surgery 2008 86, 323-326DOI: (10.1016/j.athoracsur.2008.01.091) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Facilitating the passage of the endostapler for fissure division during a thoracoscopic left basilar segmentectomy using a thin suction catheter as a guide. The fine tip is first passed behind the vessel and pulled out to attract its basis connected to the stapler jaw. (LLL = left lower lobe; LUL = left upper lobe.) The Annals of Thoracic Surgery 2008 86, 323-326DOI: (10.1016/j.athoracsur.2008.01.091) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Initiating fissure division using ultrasonic shears during a thoracoscopic left lower lobectomy. (LLL = left lower lobe; LUL = left upper lobe.) The Annals of Thoracic Surgery 2008 86, 323-326DOI: (10.1016/j.athoracsur.2008.01.091) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions