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Fig 3. Management of the left main pulmonary artery (PA) in a video-assisted thoracoscopic surgery (VATS) pneumonectomy to illustrate our technique. (A) Under thoracoscopic vision, the PA was dissected around with a conventional right-angle clamp. A #2 silk tie was about to be pulled around the vessel. (B) With traction on the silk tie, a dental pledget mounted on a right-angle clamp was used to open up the space behind the PA. Any suspicious mediastinal lymph node, like level 5, was biopsied and frozen section performed before proceeding further. (C) The frozen section of the level-5 node was benign. A vascular stapler (EndoGIA30V, Autosuture, USC) was used to staple-transect the PA. (D) Three rows of staples were left on either side of the transected PA. The final diagnosis in this patient was T2N0M0 stage Ib squamous cell carcinoma. He was discharged on postoperative day 3 and returned to his country of origin the following week. (Reprinted from Yim APC. Video-assisted pulmonary resections. In: Pearson FG, Cooper JD, Deslauriers J, et al, eds. Thoracic Surgery, 2nd ed, by permission of Churchill Livingstone [26].)
