Troubleshooting complicated hilar anatomy via prophylactically clamping the pulmonary artery: three videos demonstrating three techniques.

Complicated hilar anatomy (i.e., tumor invasion, lymphadenopathy, calcification, carbonization, and dense inflammatory adhesions) is technically challenging and often leads to catastrophic intraoperative complications and conversion to open thoracotomy during video-assisted thoracic surgery (VATS) lobectomy. The technique of prophylactically clamping the pulmonary artery (PA) has been reported to be effective in troubleshooting complicated hilar anatomy. However, there are no records on details regarding techniques to treat different hilar complication situations. In this paper, we will introduce three techniques, namely suture ligation, endo-stapler angioplasty, and suture angioplasty, for dealing with different kinds of complicated hili during VATS lobectomy through three video demonstrations.