Abstract
Aim: To report a case of fused fissure between the right upper and middle lobes that we treated using a surgical stapler rather than a Ligasure device for the benefit of creating a better division between the right upper and middle lobes and to effectively seal the lung parenchyma. Case: A 2-year-old girl with congenital cystic adenomatoid malformation of the right middle lobe (RML) was referred to our institution for further management after a series of infections. The vein of the RML, which drains into the superior pulmonary vein, was isolated and divided using endoclips. The bronchus was then exposed and divided using endo-clips. The arteries of the RML could be identified and ligated, allowing a line demarcating the major fissure to be identified and dissected. A stapler device was then used to seal the lung parenchyma and create a division between the right upper and middle lobes. She is currently well after follow-up of 16 months, with no episodes of respiratory distress or recurrence of symptoms. Conclusion: Our technique for dividing the pulmonary vein, then the bronchus, then the pulmonary artery and finally the fused fissure is safe and could be applied whenever fused fissures are encountered during thoracoscopic pulmonary lobectomy.
Highlights
With advancements in endoscopic technology and technique, thoracoscopic surgery is being used more commonly for the diagnosis and treatment of thoracic conditions in pediatrics
The vein of the right middle lobe (RML), which drains into the superior pulmonary vein, was isolated and divided using endoclips
Our technique for dividing the pulmonary vein, the bronchus, the pulmonary artery and the fused fissure is safe and could be applied whenever fused fissures are encountered during thoracoscopic pulmonary lobectomy
Summary
With advancements in endoscopic technology and technique, thoracoscopic surgery is being used more commonly for the diagnosis and treatment of thoracic conditions in pediatrics. Thoracoscopic pulmonary lobectomy can be difficult [1,2]. During major pulmonary resection using thoracoscopy, a Ligasure device (Valley lab, Boulder, CO) or bipolar sealing device is commonly used to seal the cut lung parenchyma and fissure surfaces [3]. In cases where a fissure is fused so strongly that it cannot even be identified, there is a risk for air leakage after major pulmonary resection. We report a case with a fused fissure between the right upper and middle lobes, where a surgical stapler was used instead of a Ligasure device since it was considered to be better for creating a division between the fused lobes and sealing the lung parenchyma
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