Step-wise ligation of hilum vs mass ligation during lobectomy of the lung- is it time for a change?

Abstract

The standard technique for lobectomy followed now is using the superior hilar approach and the bronchus first technique, where the pulmonary artery (PA) vessels are first divided. However, there are certain scenarios where adhesions or extensive lymphadenopathy at the hilum have distorted the vessels. Also, in case of tumors and fistulae, the bronchus and vessels may be in close proximity. Hence, it may be necessary to perform a mass ligation of the hilar structures. The separate dissection of the lobe's vein, artery, and airway forms the basis of lobectomy. The anterior approach, often known as the anterior mediastinum, is currently the most common. To our knowledge, there is limited data to compare the outcomes of step-wise ligation with mass ligation at the hilum for lobectomy. Hence we performed this study where we compared the step-wise with mass ligation of hilar structures during a lobectomy.