Harmonic HD–Powered Right Upper Lobectomy

Mr Felice Granato demonstrates a thoracoscopic right upper lobectomy, which was performed for a primary pulmonary malignancy. The Harmonic HD was adopted for sealing of one of the segmental arteries (A2). It was also used to dissect the soft tissues, the pleura, the pulmonary parenchyma, and importantly, to perform an extensive and homeostatic lymphadenectomy.

The video also demonstrates the key steps of the procedure, the segmental arterial branches of the right upper lobe, and their relationship with the surrounding structures. This anatomy is normally encountered during a right upper lobectomy and so the authors aim to provide a valuable didactic material.

They conclude that the Harmonic HD can be safely adopted to reduce the cost of video-assisted thoracoscopic lobectomy through:

1. Reduction of stapler application.
   
   1. Division of pulmonary artery vessels to a max diameter of 7 mm.
   2. Division of small portions of pulmonary parenchyma regardless the presence of surgical clips.
2. Reduction of usage of disposable instruments (eg, l-hook, dissectors, bipolar diathermy).
3. Safe blunt and sharp dissection of vascular and bronchial structures.
4. Allows a safe, lymphostatic, quick, potentially more extensive, and minimally instrumented lymph node dissection.

Suggested Reading

Landman J, Kerbl K, Rehman J, et al. Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model. J Urol. 2003;169(2):697-700.

Liu CY, Lin CS, Shih CH, Liu CC. Single-port video-assisted thoracoscopic surgery for lung cancer. J Thorac Dis. 2014;6(1):14-21.

Molnar TF, Benko I, Szanto Z, Laszlo T, Horvath OP. Lung biopsy using harmonic scalpel: a randomised single institute study. Eur J Cardiothorac Surg. 2005;28(4):604-606.