ABSTRACT

Preop General endotracheal anesthesia with double lumen tube or bronchial blocker,

epidural catheter, arterial line, Foley catheter.

Procedure Step 1. Appropriate lateral decubitus position. Step 2. Posterior lateral thoracotomy entering the chest through the 4th or 5th

intercostal space. Step 3. Free any adhesions between the lung and chest wall and assess resectability. Step 4. Deflate lung and retract it posteriorly and inferiorly to expose the hilum. Step 5. Incise the mediastinal pleura anteriorly around the hilum. Step 6. Sample Levels 5, 6, 7, 8 and 9 mediastinal lymph nodes in cancer cases. Step 7. Identify the pulmonary artery and superior pulmonary vein. Step 8. Dissect down to the adventitia of the pulmonary artery and mobilize and

encircle it. Test clamp the pulmonary artery to confirm cardiovascular stabilility. Step 9. Ligate the main trunk of the pulmonary artery and its first branches,

then transect the artery. Alternatively the artery may be divided between rows of vascular staples.