Mark K. Ferguson, MD, Cathy Bennett, PhD

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Presentation transcript:

Identification of Essential Components of Thoracoscopic Lobectomy and Targets for Simulation Mark K. Ferguson, MD, Cathy Bennett, PhD The Annals of Thoracic Surgery Volume 103, Issue 4, Pages 1322-1329 (April 2017) DOI: 10.1016/j.athoracsur.2016.12.021 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Mean scores for effort required individual components of a thoracoscopic right upper lobectomy. Error bars represent 1 standard deviation. Cognitive-only components are depicted in blue, most procedural components are maroon, and procedural components subsequently identified as being most important for simulation are green. The components are as follows: (1) perform time out; (2) perform bronchoscopy; (3) request isolation of target lung; (4) identify appropriate port locations; (5) place ports; (6) divide pulmonary ligament; (7) dissect level R8, R9 nodes; (8) dissect level 7 nodes; (9) open space posteriorly between bronchus intermedius and right upper lobe bronchus to facilitate anterior dissection; (10) dissect level R4 nodes; (11) divide pleura superior to the hilum between right upper lobe and azygos vein; (12) divide pleura over anterior aspect of the hilum; (13) dissect nodal packet between superior pulmonary vein and pulmonary artery; (14) isolate and divide vein draining the upper lobe, preserving vein draining the middle lobe; (15) dissect lymphovascular packet between truncus anterior and interlobar portion of the artery, just anterior to the right upper lobe bronchus; (16) isolate and divide the truncus anterior; (17) Dissect R11 nodes anterior to RUL and at the division between the RUL and bronchus intermedius; (18) isolate and divide posterior segmental artery; (19) isolate and divide upper lobe bronchus after identifying the bronchus intermedius and the crotch between the two structures; (20) complete minor fissure; (21) complete major fissure; (22) chest drain placement; (23) lung reexpansion, including assessment of bronchial stump for integrity and parenchyma for air leaks; (24) port site closure. The Annals of Thoracic Surgery 2017 103, 1322-1329DOI: (10.1016/j.athoracsur.2016.12.021) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions