Page 31 - Read Online

Gharagozloo et al. Mini-invasive Surg 2020;4:55 I http://dx.doi.org/10.20517/2574-1225.2020.42 Page 7 of 13

Figure 7. The ULV is elevated, the leader catheter portion of a vascular stapler is passed underneath. ULV: upper lobe vein

Figure 8. The anterior ATPA branch is elevated, encircled, and the leader catheter portion of a vascular stapler is used to position the
stapler. ATPA: apical trunk pulmonary artery

accessory port by the assistant (Covidien Signia gold tip with leader catheter with white 45 cartridges)
[Figure 7].

Next, the anterior apical trunk pulmonary artery branch is encircled with a vessel loop and transected with
a linear stapler in the same fashion as the vein [Figure 8].

The Lung is once again reflected anteriorly, thereby exposing the posterior aspect of the hilum. The right
upper lobe bronchus is identified from a posterior approach and it is separated from the main pulmonary
artery which lies underneath. The RUL bronchus is encircled with a vessel loop and transected using a
stapler with a green cartridge. Before firing the stapler, the anesthesiologist must make certain that the
suction catheter in the endotracheal tube is removed [Figure 9].

After this maneuver, the posterior segmental pulmonary artery is exposed and divided. This vessel is
usually smaller than 6 mm and therefore can be divided with a vessel-sealing device and the proximal
stump is further reinforced with a small Titanium clip applied with the robotic Endowrist small clip applier.

Next, the fissure between the right upper lobe and the right middle lobe is divided with gold or purple
stapler from an anterior to posterior direction [Figure 10]. Finally, the lung is retracted superiorly, the