Anatomic lobectomy of the lung by means of thoracoscopy. An experimental study.

We conducted this study in an attempt to investigate whether anatomic lobectomy can be performed through a thoracoscope. Twelve lower (seven left and five right) and six left upper lobectomies were done in 17 pigs weighing 60 to 90 kg. With the use of general anesthesia and one-lung ventilation, a thoracoscope and operating instruments were inserted through four or five trocars. First, the incomplete fissure was bluntly dissected with specially designed cotton-tipped dissectors and divided by an electrocautery spatula or sapphire contact-tip neodymium: yttrium aluminum garnet laser probe. The pulmonary artery and its branches were similarly dissected. Two ligatures were passed around the vessels by endoscopic right-angle clamps and tied by means of an extracorporeal tying technique. The vessels were clipped and divided. In two animals, a hidden branch of the pulmonary artery was inadvertently cut. Bleeding was readily controlled with the dissector until metal clips could be applied. The bronchus was similarly dissected and divided and the proximal stump was closed with sutures. The pulmonary vein was dissected bluntly by the same technique and divided. The excised lobe was placed in a plastic bag and pulled out through one of the trocar holes after the hole had been enlarged to 3 cm. Blood loss was minimal. In conclusion, anatomic lobectomy of the lung by means of thoracoscopy was feasible in the pig.