Mayo stand and back table instruments for Open Lobectomy surgery setup

Clamping & Occluding

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  Allis Forceps

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  Curved Hemostat

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  Debakey Peripheral Vascular Clamp

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  Gemini Mixter Artery Clamp

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  Rummel Thoracic Artery Forcep

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  Stille Vessel Clamp

Cutting & Dissecting

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  #3 Knife Handle

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  Jorgensen Thoracic Scissor

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  Metzenbaum Scissor

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  Straight Mayo Scissor

Grasping & Holding

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  Adson Forceps

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  Collins Duval Forceps

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  Debakey Forcep

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  Forester Sponge Forceps

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  Kantrowitz Forceps

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  Potts-Smith Forceps

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  Vanderbilt Deep Vessel Forceps

Misc

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  Doyen Rasparatory

Retracting & Exposing

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  Adson Periosteal Elevator

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  Burford Rib Spreader

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  Davidson Scapula Retractor

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  Doyen Retractor

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  Finochietto Rib Retractor

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  Harken Rib Retractor

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  Ribbon retractor

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  Richardson Retractor

Suctioning

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  Yankauer Suction

Suturing & Stapling

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  Crile Wood Needle Holder

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  Mayo-Hegar Needle Holder

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  Ryder Needle Holder

What to expect during Open Lobectomy

Open lobectomy is a surgical procedure that involves removing a section of one of the lobes of the lung. It is often performed to treat lung cancer or other conditions that affect the lungs, such as chronic obstructive pulmonary disease (COPD). During the procedure, the surgeon makes a large incision in the patient’s chest and uses specialized tools to remove the affected lobe. Open lobectomy is a major surgery that requires general anesthesia and a hospital stay of several days. However, it can be an effective treatment option for those with serious lung conditions.

The most popular approach for Open Lobectomies is the anterior approach. Dissection will occur from anterior to posterior, all in one direction.

Step 1: Incision and Rib Spreader Insertion
The first step in an Open Lobectomy is making an incision halfway between the back of the scapula and the spinal processes. This incision will provide access to the thoracic cavity. Once the incision is made, the surgeon will dissect the tissue down and insert a rib spreader of their choice for retraction throughout the remainder of the case until closure. This allows for better visualization of the surgical site and facilitates the dissection process.

Step 2: Dissection from Anterior to Posterior
After the rib spreader is in place, the surgeon will start the dissection from anterior to posterior, all in one direction. The goal is to carefully dissect around the hilum of the lung to free up the pleura, so that underlying structures can be identified and divided. This involves the use of various instruments such as dissectors, scissors, and electrocautery to carefully separate the tissues and expose the targeted structures.

Step 3: Ligament Dissection and Removal
During the dissection, the surgeon will encounter ligaments, such as the inferior pulmonary ligament, which may need to be taken down. This allows the lower lobe of the lung to expand and facilitates the removal of the targeted lobes. Various staplers, such as linear cutters or stapling devices, may be used to remove these ligaments and lobes. The choice of stapler will depend on the surgeon’s preference and the specific anatomy of the patient.

Step 4: Bronchus Stapling and Lymph Node Removal
As the dissection progresses, the bronchus of the targeted lobe will eventually be exposed and identified. The surgeon will then use a stapling device to carefully staple and remove the bronchus. This is a critical step in the lobectomy procedure, as it involves the complete removal of the targeted lobe. In addition, depending on the reason for the surgery, lymph nodes in the area may also need to be removed for further evaluation. This can be done using various instruments such as lymph node forceps or dissectors.

Tips and tricks
Throughout the procedure, the surgeon may need to gradually switch to longer instruments as they go deeper into the thoracic cavity. This allows for better access and manipulation of the tissues during the dissection process. The choice of instruments will depend on the surgeon’s preference and the specific needs of the case.

The Surgery Sparknotes

1. Make incision and insert rib spreader for retraction.
2. Dissect from anterior to posterior to free up pleura and identify/divide structures.
3. Take down ligaments using staplers.
4. Staple and remove bronchus, consider lymph node removal.