Open Left Upper Lobectomy in an Adult Cystic Fibrosis Patient

1. Introduction

2. Incision and Fascial Dissection

1. Position Patient
2. Mark Incision
3. Make Initial Incision

3. Muscle Harvesting

1. Score Rib for Periosteum Harvest
2. Remove Periosteum from Sixth Rib
3. Remove Periosteum from Fifth Rib
4. Harvest Intercostal Muscle

4. Infrapyloric Mobilization

1. Shingle Sixth Rib
2. Spread Ribs
3. Complete Harvest of Intercostal Muscle Flap

5. Dissection of Pulmonary Structures

1. Remove Adhesions
2. Dissect Hilum and Pleura
3. Take Down Inferior Pulmonary Ligament
4. Dissect Superior and Inferior Pulmonary Veins
5. Mobilize Plurae off Pulmonary Artery
6. Create Approach Around Superior Pulmonary Vein

6. Removal of Lung Lobe

1. Transect Pulmonary Vein
2. Transect Apical Pulmonary Artery Branches
3. Divide Airway off of Pulmonary Artery
4. Transect Bronchus
5. Resect Left Upper Lobe
6. Reinforce Staple Line

7. Closure

1. Place Chest Tubes
2. Close Ribs
3. Close Muscle Layers
4. Close Skin

8. Post-op Remarks