Right upper lobectomy: BAV (order to take Bronchus, Artery, Vein)
Posterior dissection to isolate and divide the right upper lobe bronchus.
The pulmonary artery is next exposed and the major fissure is opened.
The branch pulmonary vessels to the right upper lobe are isolated and divided.
Finally, the right upper lobe vein is isolated and divided. The minor fissure is divided.
Right middle lobectomy: AVB
The major fissure is opened, and the middle lobe pulmonary arteries are isolated and divided.
The middle lobe vein is exposed anteriorly and divided.
Finally, the middle lobe bronchus is isolated and divided.
Right lower lobectomy: VBA
If the pulmonary artery is readily accessible, the right lower lobe's pulmonary artery is exposed and divided. Alternatively, if the fissure is incomplete, the inferior pulmonary vein can be isolated after division of the inferior pulmonary ligament.
Next, the lower lobe bronchus is isolated and divided with care to avoid narrowing the right middle lobe bronchus.
Finally, the lower lobe pulmonary artery is isolated and divided and the major fissure is divided.
Left upper lobectomy: AVB
Posteriorly the main pulmonary artery is exposed, which allows the major fissure to be opened.
The branch pulmonary vessels to the upper lobe are isolated and divided.
The upper lobe vein is isolated and divided, and lastly the upper lobe bronchus is divided.
Left lower lobectomy: VBA
Same right lower lobectomy.
Educational aid only. Verify every dose, indication, and guideline against current institutional protocol. This is not a substitute for clinical judgment.
