Securing and Treatment of Interlobar Pulmonary Artery in Severe Insufficient Interlobar Fissure of the Lung

: There are 2 surgical approaches to secure and treat interlobar pulmonary artery in severe insufficient interlobar fissure of the lung. One is an interlobar approach which is called "fissure first technique". This approach is standard, but sometimes difficult to secure interlobar artery safely. So, lung parenchyma injury and accidental bleeding from the pulmonary artery become troublesome problems. On the other hand, hilar approach without contacting to interlobar fissure which called "hilar first technique" is very useful to avoid lung parenchyma injuries. There are some knack and pitfalls in every lobe of the lung. The key of this approach is to be familiar with the anatomical position of pulmonary artery running by confirming preoperative 3-dimensional computed tomography( 3D-CT). In the final step of this technique cutting the interlobar line exactly is more important to prevent atelectasis and congestion of residual lung. It is very important for thoracic surgeons to know the details of both approaches in the surgical treatment of severe insufficient interlobar fissure of the lung.