Right side lobectomies

Lobectomy remains the definitive resection because assures removal of the regional lymph nodes and thus provides the best information for staging and local control. Doing less than a lobectomy must be considered a compromise because a wedge excision does not include the lobar bronchus, impeding evaluation of lobar lymph nodes, but also usually it provides only a minimal parenchymal margin and, thus, is accompanied by a significant incidence of local recurrence. Before the operation, at a minimum, patients should have a recent chest CT scan and a Positron Emission Tomography scan. Preoperative spirometry should be performed including forced expiratory volume in 1 second (FEV₁), diffusive capacity, FEV₁/forced vital capacity (FVC) ratio, and the ratio of the residual volume (RV) to total lung capacity (TLC). FEV₁ <40% and a reduced diffusing capacity of predicted have been associated with increased postoperative morbidity and mortality. A valuation of exercise capability for the patient with compromised lung function may be appropriate and the value of maximal oxygen consumption (VO₂ max) <15 mL/kg/min has been associated with significantly increased postoperative morbidity and mortality. Lobectomies are approached via standard lateral decubitus position. The pleural cavity is entered through the fifth intercostal space or the bed of the fifth rib using a muscle sparing thoracotomy if possible. The key to an orderly lobectomy is an accurate knowledge of the anatomy of the pulmonary artery, the variations of branching, and its proper dissection.