Total thoracoscopic high-position sleeve lobectomy of the right upper lobe of the lung.

This video demonstrates a total thoracoscopic high-position sleeve lobectomy of the right upper lobe in patients with central lung cancer. A 50-year-old male was admitted to the hospital due to a two-month history of coughing. His previous medical history was unremarkable. On admission, physical examination revealed reduced breath sounds in the right upper lung, but no significant rales were present. Chest CT scan revealed a mass in the right upper lung near the lung hilum, atelectasis of the right upper lobe, and enlarged right hilar lymph nodes. No significantly enlarged mediastinal lymph node was noted. Bronchoscopy revealed occlusion of the right upper lobe bronchus by the tumor. Pathological examination of the obtained biopsy reveled squamous cell carcinoma. The required preoperative examinations were completed, and no distant metastasis was evident. Total thoracoscopic sleeve resection of the right upper lobe was performed via the "three-port approach" in which the anterior port was the main operating port. First, the inferior pulmonary ligament was dissected to remove the lymph nodes of station 9. Next, the lymph nodes of stations 7 and 8 were removed. Third, the lymph nodes in the region between the intermediate bronchus and the right upper lobe were dissected. Then, the dissection continued superiorly to remove mediastinal lymph nodes of stations 2 and 4 followed by successful anatomic right upper lobectomy, which briefly included division of the superior pulmonary arteries and veins, skeletonization of the upper right lobular bronchus, localization via incision by a sharp blade, division of the bronchus with scissors, and anastomosis with 3-0 prolene continuous suture. The surgery was successful. The postoperative pathological stage was T4N1M0 (stage IIIA).