1. 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 (April 2017)
DOI: /j.athoracsur
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

2. 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  , DOI: ( /j.athoracsur )
Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions