Left upper lobe

Abstract

Left upper lobectomies are reputed to be hazardous because of the need of controlling the mediastinal branches of the pulmonary artery, which can be short and fragile. Any tear would cause massive hemorrhage and would require immediate conversion to thoracotomy. Thus, an endoscopic approach for left upper lobectomy may seem unreasonable. However, thanks to the close-up vision and magnification provided by the thoracoscope, dissection can be accurate and safe. Two anomalies should lead to abandon the procedure and convert to thoracotomy: (1) a very short truncus anterior, especially if it is partly obscured by the lobar bronchus, and (2) adherent lymph nodes.