♦ Preoperative
Operative Planning
- Review chest x-ray
Equipment
- Basic tray
- Thoracotomy tray in room immediately available
- Rigid 11-mm endoscopic port with trocar
- Endoscopic paddle bipolar cautery, cauterizing scissors, and Kittner dissectors
- Harmonic scalpel (optional)
- 28-French (F) chest tube
Operating Room Set-up
- Five- and/or 10-mm straight (0 degree) thoracoscope with three-chip camera and dual video monitors. Monitors placed at head of bed on either side for comfortable, straight ahead viewing.
- Double lumen endotracheal tube
- Flexible bronchoscope (to confirm satisfactory endotracheal placement)
- Intravenous antibiotics prior to incision
♦ Intraoperative (Fig. 147.1)
Positioning
- Patient supine with both arms abducted 90 degrees (perpendicular to torso)
- Ten degrees reverse Trendelenburg initially; may increase and use rotation as needed, obviates need for lung retraction
Planning of Sterile Scrub and Preparation
- No shave needed
- Include upper arms, axillae, and chest
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