Extended right-sided lower lobectomy in patients with lung cancer involves the removal of regional lymph nodes: intrapulmonary (inferior and inferior interlobar), inferior root and mediastinal.
The lung is divided along the interlobar fissure, separating the lower lobe affected by the tumor. Cross the pulmonary ligament and dissect the mediastinal pleura from the diaphragm to the lower pulmonary vein. The lower pulmonary vein is isolated, bandaged and crossed. After this, dissection of the interlobar lymph nodes, grouped mainly along the lower lobe artery, becomes available. The interlobar lymph nodes dissect upward along the wall of this vessel to the interlobar trunk at the site of formation of the mid-lobar artery. The artery of the lower lobe thus isolated is ligated and intersected. Along the anterior surface of the bronchus of the lower lobe of the lung, the lymph nodes of the inferior group stand out to the middle lobe and intermediate bronchi.Mobilized by this technique, regional lymph nodes are removed or shifted to the lower lobe of the lung to be resected. The inferior bronchus is stitched and crossed.
After removal of the lower lobe together with the intrapulmonary groups of the regional lymph nodes, the lower root and mediastinal parts of the lymphatic collector of the right lung are prepared. The selection of these groups of lymph nodes is carried out along the lower surface of the right main bronchus in the direction from the bronchus stump to the lower lobe of the lung to the trachea bifurcation and the initial section of the left main bronchus. Subsequently, cellulose mobilized in this way with bifurcation lymph nodes is prepared downwards — along the anterior-lateral surface of the esophagus. The bifurcation and peri-esophageal lymph nodes of the mediastinum with the surrounding fiber are separated and removed in one block. This stage of the operation is sometimes referred to as lower mediastinomy with lymphadenectomy .
In order to ensure oncological radicalism of surgery in patients with advanced stages of lung cancer, with regional metastases of the mediastinum affected by metastases — bifurcation and peri-esophageal — wide removal of the upper groups of lymph nodes is also required.
The upper and middle lobes of the right lung are taken outwards and downwards. Allocate, bandage and cross the unpaired vein. The central stump is captured with a hemostat. With its help, several raise and withdraw the superior vena cava to the mediastinum. The mediastinal pleura is dissected to the dome of the pleural cavity. remove the right tracheobronchial, paratracheal and prevenal lymph node groups. The mediastinal stage of the operation is completed with restoration of the sutures of the mediastinal pleura.