Treatment of a densely fused fissure during thoracoscopic right middle lobectomy

Hiroyuki Koga, Kenji Suzuki, Tadaharu Okazaki, Kinya Nishimura, Geoffrey J. Lane, Atsuyuki Yamataka

Department of Anesthesiology, Juntendo University School of Medicine, Tokyo, Japan.
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Department of Thoracic General Surgery, Juntendo University School of Medicine, Tokyo, Japan.

DOI: 10.4236/ojped.2013.32020                

Abstract

Aim: To report a case of fused fissure between the right upper and middle lobes that we treated using a surgical stapler rather than a Ligasure device for the benefit of creating a better division between the right upper and middle lobes and to effectively seal the lung parenchyma. Case: A 2-year-old girl with congenital cystic adenomatoid malformation of the right middle lobe (RML) was referred to our institution for further management after a series of infections. The vein of the RML, which drains into the superior pulmonary vein, was isolated and divided using endoclips. The bronchus was then exposed and divided using endo-clips. The arteries of the RML could be identified and ligated, allowing a line demarcating the major fissure to be identified and dissected. A stapler device was then used to seal the lung parenchyma and create a division between the right upper and middle lobes. She is currently well after follow-up of 16 months, with no episodes of respiratory distress or recurrence of symptoms. Conclusion: Our technique for dividing the pulmonary vein, then the bronchus, then the pulmonary artery and finally the fused fissure is safe and could be applied whenever fused fissures are encountered during thoracoscopic pulmonary lobectomy.

Keywords

Thoracoscopic Surgery; Pulmonary Lobectomy; Fused Fissure; Surgical Stapler

Conflicts of Interest

The authors declare no conflicts of interest.

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