[Resection and Reconstruction of the Diaphragm and the Pericardium in Extrapleural Pneumonectomy].

The diaphragm dissection should be started from anterior, because the portion is just under the thoracotomy incision. The diaphragmatic muscle was cut by an electric knife along the line of 1 to 2 cm from the chest wall from anterior and lateral to posterior. The diaphragm including the tendon center is dissected from the peritoneum. The peritoneum should be preserved. If the peritoneum is opened, it should be repaired by sutures. The pericardium is opened at the apex. The pericardium incision is extended from the apex to cranial side. And then, it is cut from the apex to posterior with the diaphragm. And next, the incision of the cranial side edge is extended to posterior. The lower pulmonary vein, upper pulmonary vein, and pulmonary artery are exposed. They are encircled and divided in the pericardium by autosutures. A Goretex sheet with 1 mm thickness is used to reconstruct the diaphragm. Nine sutures were placed in advance for the Goretex, and pulled out from the chest cavity through upper and lower sides of the 10th or 9th rib. The sutures were tied outside the rib cage. For mediastinal side, the Goretex was sutured to the residual diaphragm. A Goretex sheet with 0.1 mm thickness is used to reconstruct the pericardium by interrupted sutures. Because the contralateral lung is overinflated, the reconstruction should not be tight. Slits for the Goretex are made to prevent regional tamponade.