[Fissure-less Technique for Patients with Incomplete Fissures].

Dissection through an incomplete fissure for pulmonary artery exposure leads to complications such as prolonged air leaks, atelectasis, and congestion. One way to resolve these problems is the fissure-less technique, in which the hilar vessels and bronchi are dissected first, and the fissure is divided last. This approach has the advantage that the fissure can be relatively easily identified and postoperative air leakage is minimized because the fissure division is performed last. Another advantage is that it is easier to keep enough distance from the tumor, especially if the tumor is close to the fissure. Since this method involves surgical manipulation under a different field of view than the interlobar approach, it is important not to misdiagnose the anatomy of the pulmonary artery and other organs. In order to prevent incorrect surgical manipulation, it is necessary to read the computed tomography (CT) findings preoperatively and to understand the anatomy intraoperatively. In addition, to prevent destruction of the hilar lymph nodes, dissection around the bronchus must be carefully performed. Furthermore, when it is difficult to make a judgment intraoperatively, careful attention is required, such as checking the CT scan again. The fissure-less approach is a technique that should be mastered as one way to deal with incomplete fissure.