흉선절제술 open thymectomy

open thymectomy 흉선절제술

-적응증: thymus mass, r/o thymoma

whole lung dense adhesion : adhesiolysis

lung , pericardium, SVC, Innominate vein 으로 invasion 된 tymus mass

 

 

 

 

 

 

 

 

 

 

1.VATS 하에 thymus mass확인

1)made routine VATS port

trocar : 5mm *3ea, 12mm*1ea (endo GIA 용)

5mm scope + light  cable

 

2)performed adhesiysis, dissected perithymic tissue 

vats instrument : nodal fcp으로 dissection

wolf fcp

harmonic long type

hook type bovie 

endo 용 suction

 

3)performed wedge resection of Lobe

Endo GIA : thymus mass가 lung invasion 되어 있을 경우 purple 60 으로 wedge resection 

->neovil M

 

4)Excision of pericardium

endo metz

 

 

2.partial upper sternotomy 

1)performed partial sternotomy 

10mess incision -> bovie

army 로 retractomy 

sternal saw로 sternotomy 

->self retractor (retractor set내에 있는 중간 self retractor)

 

2)divided innominate vein, SVC

rt angle, debakey

black metz

black silk 1/0 

bovie, harmonic

 

3)divided SVC

mass가 SVC에도 Invasion 되어 vascular clamp (lobectomy 부속 set내에 있는 긴 curved 모양) 으로 clamp하여 

mass와 함께 resection 함 

 

 

 

->prolene 4/0(thoracotomy set내의 긴 needle holder)를 이용하여 primary closure 

->SVC Suture site로 tachosil apply

 

4)bleeding control, irrigation

neovil (m) apply 

introduced 28Fr chest tubes

 

5)closed wound by laysers

sternotomy : steel wire -> 1/0 vicryl -> 3/0 vicryl 

vats port : 2/0 J type -> 3/0