There were 74 cases (29.5%) with adhesive and fissureless complications in comparison with all 251 cases who had undergone video-assisted thoracic surgery (VATS) lung operations in author’s hospital. On lobectomy and segmentectomy adhesive and fissureless effective factors were old age( p=0.012), the difference between %DLco to %DLco/VA( p<0.05), Brinkman index( p=0.043) compared with non-ad- hesive cases, therefore operation times of fissureless group prolonged (p=0.009). The point at issue was in what manner we should perform appropriate division of the bronchus, the pulmonary arteries and the veins on the fissureless lobectomy. Especially it is very important which the apicoposterior artery( rA2b:Asc) on right upper lobectomy and the lingular segmental artery( lA4+5) on left upper lobectomy branch from the major fissure or not. For that purpose the management procedure had been done pulmonary artery (primary upper division: A1+2+A3)→ pulmonary vein → bronchus → residual pulmonary artery (rA2b or lA4+5). On the very severe fissureless cases the management procedure had been done pulmonary vein → bronchus → pulmonary artery. Mobilization of "fissure first, hilum last" and/or "hilum first, fissure last" techniques should be performed for VATS fissureless lobectomy.
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