The first step when doing a pneumonectomy for cancer of the bronchus is to:
|A||Ligate the pulmonary vein|
|B||Ligate pulmonary artery|
|C||Divide the bronchus|
|D||Perform lymph node clearance|
a. The lung is then retracted posteroinferiorly and the hilar pleura is opened posterior to the phrenic nerve.
b. The main pulmonary artery and superior and inferior pulmonary veins are evaluated for resectability.
c. The order of division of the vascular structures or bronchus is not critical and usually proceeds along the lines of the ease of dissection.
d. After sharply dividing the adventitial sheath of the main pulmonary artery, most of the isolation of the vessel can be carried out with gentle, blunt dissection. Occasionally, the truncus anterior branch of the pulmonary artery can be divided separately to provide more room for division of the right main pulmonary artery.
e. After division of the artery is complete, the superior pulmonary veins are isolated by dissecting anteriorly in the groove of pericardial reflection between the superior and inferior pulmonary veins. These veins can be similarly divided with separate applications of the stapler .