Random medical images gallery

poplitealregion

User login

Who's new

  • sungcharleston33
  • mackenziethiel9593
  • eulaliafife24426
  • rosariawaxman124
  • thad6193854836100

Who's online

There are currently 0 users and 2 guests online.

Welcome to surgicalnotes.co.uk

Surgical notes is a Free online resource for the busy surgical trainee.  

This site has been written to cover the syllabus for the MRCS viva and clinical components as well as general Surgical Science. New sections have been added for the USMLE andMRCP(UK) examinations and a brand new section on the subspeciality of Cardiothoracic surgery.

To begin, use the navigation bar at the top to reach the articles or seach directly for the item you wish to review. 

If you wish, you may register for FREE on this site.

Thanks for visiting!

  • : Function ereg() is deprecated in /homepages/43/d28106701/htdocs/sn/includes/file.inc on line 646.
  • : Function ereg() is deprecated in /homepages/43/d28106701/htdocs/sn/includes/file.inc on line 646.
  • : Function ereg() is deprecated in /homepages/43/d28106701/htdocs/sn/includes/file.inc on line 646.
  • : Function ereg() is deprecated in /homepages/43/d28106701/htdocs/sn/includes/file.inc on line 646.
  • : Function ereg() is deprecated in /homepages/43/d28106701/htdocs/sn/includes/file.inc on line 646.
  • : Function ereg() is deprecated in /homepages/43/d28106701/htdocs/sn/includes/file.inc on line 646.
  • : Function ereg() is deprecated in /homepages/43/d28106701/htdocs/sn/includes/file.inc on line 646.
  • : Function ereg() is deprecated in /homepages/43/d28106701/htdocs/sn/includes/file.inc on line 646.
  • : Function ereg() is deprecated in /homepages/43/d28106701/htdocs/sn/includes/file.inc on line 646.
  • : Function ereg() is deprecated in /homepages/43/d28106701/htdocs/sn/includes/file.inc on line 646.
  • warning: Parameter 2 to views_rss_views_feed_argument() expected to be a reference, value given in /homepages/43/d28106701/htdocs/sn/includes/module.inc on line 406.

Indications

  • Locally advanced tumour entering bronchial tree

 

Relative risks

  • Death 1-2%
  • Atrial fibrillation
  • Thromboembolism
  • Bleeding
  • Infection
  • Persistent air leak

 

Procedure

  1. Pre-operative bronchoscopy: check lesion position
  2. Postero-lateral thoracotomy
  3. Chest opened through 5th ICS
  4. Harvest intercostal muscle bundle (to protect anastomosis)
  5. Check pleural cavity for deposits, effusion, completeness of fissures
  6. Pulmonary ligament diveided up to inferior pulmonary vein (allows identification of IPV and also allows lung to move up when re-expanding)
  7. Anterior and superior hilum dissected to expose superior pulmonary vein and main pulmonary artery with proximal branches
  8. Staple pulmonary vein
  9. Limited clearance of adventitia from proximal left main bronchus and upper lobe bronchus
  10. Bronchus divided distally to upper lobe bronchus
  11. Inspect margin
  12. 2/0 prolene stay sutures through proximal and disal bronchial stumps at junction of cartilaginous and membranous parts
  13. Bronchial anastomosis fashioned under aortic archwith continous 4/0 PDS to membranous bronchus, interrupted 4/0 prolene to cartilage with telescoping od smalled distal bronchus to main stem
  14. Intercostal bundle interposed between PA and bronchial anastomosis and wrapped around
  15. Lymph nodes sampled
  16. Washout with warm water to check for air leak
  17. Post-op bronchoscopy checking anastomosis with patency

 

Post op

  • Chest X-ray
  • Chest drains on suction 3-5kPa

Quick Links