Technique: Blinded Left Upper Lobectomy

The patient was a 4 month old, 5 kg infant with a prenatally diagnosed CAM (congenital adenomatoid malformation).

An anterior approach was used with 3 ports: a 4 mm port in the posterior axillary line for the telescope, and two 3 mm ports in the anterior axillary line.

The lower port was later changed to a 5 mm port for access of the endoscopic clip applier.

A new 3 millimeter sealer dissector was used for the case.

The sealer was used to compress cysts in the left upper lobe to allow for easier access to the pulmonary vessels.

The main trunk of the artery to the upper lobe was dissected out and sealed proximally and distally, then divided between the seals.

This sealing technique allows for a safe, effective and reproducible method for sealing pulmonary vessels without risk of bleeding.

Each of the main branches of the superior pulmonary vein were individually isolated, dissected out, and then sealed proximally and distally with division of the vessel between the seals.

The major fissure was incomplete anteriorly.

The sealer was used to help define the plane of the incomplete major fissure, and the lung between the upper and lower lobes was sealed and then divided.

Almost a finger fracture technique was used to divide the lung parenchyma and expose the artery as the dissection continued posteriorly towards the main pulmonary arteries.

The superior and inferior branches of the lingular artery were individually isolated, sealed, and divided using the 3 millimeter sealer.

The bronchus to the lingula was sealed with a 5 millimeter clip applier, both proximally and distally, and divided between these clips.

5 millimeter clips have proven to be an effective way to seal the bronchus in infants under 10 kg.

Each bronchial branch (apical posterior and anterior) was individually sealed with a 5 millimeter clip and then divided proximal to this.

The upper lobe was brought out through the lower trochar site in a piecemeal fashion.

The child had a chest tube in for 24 hours and was discharged on the 2nd postoperative day.