| Takedown of inferior pulmonary ligament, division of pleura |
Identification of station 8/9 lymph nodes, energy device use, hemostasis, lung retraction |
Injury to esophagus, Inferior vein, vagus, lung, bronchus intermedius, no-touch tumor |
| Dissect subcarinal posterior/paratracheal/hilar nodes |
Correct identification of mediastinal nodal stations, en bloc dissection, avoidance of grabbing node (fracture), energy device use, hemostasis, lung retraction |
Injury to vagus, R recurrent laryngeal nerves, lung, esophagus, airway, azygos, pulmonary artery, SVC, aorta |
| Dissect/divide superior vein |
Vascular dissection (grabbing vein allowed), energy, stapler use |
RML vein, phrenic, PA |
| Dissect superior hilar/peribronchial nodes |
Node grabbing technique, en bloc dissection, energy, retraction (on vessels, bronchus) |
Pulmonary artery, bronchus |
| Dissect/divide pulmonary arteries |
Multiple vessels, vascular dissection (no-grab), energy, stapler use, clip use, energy division of artery and appropriate selection |
Pulmonary artery, azygos |
| Dissect/divide bronchus |
Energy, retraction, stapler use, recognition of correct structures |
RUL bronchus, RMB, azygos, PA |
| Complete posterior/horizontal fissure |
Stapler use, retraction, visualization of divided hilum |
Phrenic nerve, bronchus intermedius, RML artery, lung parenchyma |
| Management of PA injury |
Tamponade (lung, sponge, time dependent), retraction of camera, decision to convert, request additional staff, communication, blood request |
Grabbing vessel, delay |
