Intravascular Stapling Technique for Interlobar Fissure Division in the Left Lower Lobectomy

INTRODUCTION: Prolonged air leak is the most common complication after pulmonary resection. This occurs more frequently in patients with incomplete interlobar fissure, chronic obstructive pulmonary disease, or emphysema. Interlobar lymphadenopathy can make interlobar fissure division difficult. SURGICAL TECHNIQUE: Several techniques of interlobar fissure division have been documented. The interlobar fissure is routinely divided using a stapler during pulmonary lobectomy. Normally, a stapler is used extravascularly. Here, we present a patient who successfully underwent interlobar fissure division wherein the jaw of the stapler passed through the interlobar pulmonary artery between A6 and A8 branches during resection of a lung squamous cell carcinoma in the left lower lobe with an interlobar lymphadenopathy. CONCLUSION: Interlobar fissure division inserting a jaw of stapler into pulmonary artery is easy and useful option for left lower lobectomy. This technique is especially useful for a patient with an interlobar lymphadenopathy.