Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Video-Assisted Thoracic Surgery Segmentectomy

  • Kim, Ha Eun (Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Yang, Young Ho (Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Chang Young (Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2021.06.07
  • Accepted : 2021.07.27
  • Published : 2021.08.05
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Abstract

Although lobectomy remains the gold-standard surgical treatment for non-small-cell lung cancer, the frequency of thoracoscopic segmentectomy is increasing. Multiple factors must be considered in the choice of the procedure, ranging from adequate surgical planning or simulation, tumor localization, and identification of the intersegmental plane to severing the intersegmental plane to achieve an oncologically safe surgical margin with no or minimal manual palpation and different landmarks. In this article, we present an overview of methods for each procedural step of thoracoscopic segmentectomy, from preoperative planning to division of the intersegmental plane.

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References

  1. Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143(5 Suppl):e278S-e313S. https://doi.org/10.1378/chest.12-2359
  2. Cao C, D'Amico T, Demmy T, et al. Less is more: a shift in the surgical approach to non-small-cell lung cancer. Lancet Respir Med 2016;4:e11-2. https://doi.org/10.1016/S2213-2600(16)00024-2
  3. Gu C, Wang R, Pan X, et al. Sublobar resection versus lobectomy in patients aged ≤35 years with stage IA non-small cell lung cancer: a SEER database analysis. J Cancer Res Clin Oncol 2017;143:2375-82. https://doi.org/10.1007/s00432-017-2499-y
  4. Traibi A, Grigoroiu M, Boulitrop C, et al. Predictive factors for complications of anatomical pulmonary segmentectomies. Interact Cardiovasc Thorac Surg 2013;17:838-44. https://doi.org/10.1093/icvts/ivt292
  5. Shiono S, Okumura T, Boku N, et al. Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg 2017;51:504-10.
  6. Berry MF. Role of segmentectomy for pulmonary metastases. Ann Cardiothorac Surg 2014;3:176-82.
  7. Melloni G, Carretta A, Ciriaco P, et al. Inflammatory pseudotumor of the lung in adults. Ann Thorac Surg 2005;79:426-32. https://doi.org/10.1016/j.athoracsur.2004.07.077
  8. Igai H, Kamiyoshihara M, Nagashima T, Shimizu K. Anatomical segmentectomy for pneumothorax associated with congenital bronchial atresia. Eur J Cardiothorac Surg 2013;43:198. https://doi.org/10.1093/ejcts/ezs377
  9. Inoue T, Oizumi H, Nakamura M, Sadahiro M. Port-access thoracoscopic anatomical segmentectomy for pediatric intralobar pulmonary sequestration. Thorac Cardiovasc Surg Rep 2014;3:42-4. https://doi.org/10.1055/s-0034-1377065
  10. Shimizu K, Nakazawa S, Nagashima T, Kuwano H, Mogi A. 3D-CT anatomy for VATS segmentectomy. J Vis Surg 2017;3:88. https://doi.org/10.21037/jovs.2017.05.10
  11. Nagashima T, Shimizu K, Ohtaki Y, et al. An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography. Gen Thorac Cardiovasc Surg 2015;63:354-60. https://doi.org/10.1007/s11748-015-0531-1
  12. Nagashima T, Shimizu K, Ohtaki Y, et al. Analysis of variation in bronchovascular pattern of the right middle and lower lobes of the lung using three-dimensional CT angiography and bronchography. Gen Thorac Cardiovasc Surg 2017;65:343-9. https://doi.org/10.1007/s11748-017-0754-4
  13. Shimizu K, Nagashima T, Ohtaki Y, et al. Analysis of the variation pattern in right upper pulmonary veins and establishment of simplified vein models for anatomical segmentectomy. Gen Thorac Cardiovasc Surg 2016;64:604-11. https://doi.org/10.1007/s11748-016-0686-4
  14. Zhang M, Mao N, Zhang K, et al. Analysis of the variation pattern in left upper division veins and establishment of simplified vein models for anatomical segmentectomy. Ann Transl Med 2020;8:1515. https://doi.org/10.21037/atm-20-6925
  15. Boyden EA, Scannell JG. An analysis of variations in the bronchovascular pattern of the right upper lobe of 50 lungs. Am J Anat 1948; 82:27-73. https://doi.org/10.1002/aja.1000820103
  16. Yamashita H. Variations in the pulmonary segments and the bronchovascular trees. In: Yamashita H, editor. Roentgenologic anatomy of the lung. Tokyo: Igaku-Shoin; 1978. p. 70-107.
  17. Gossot D, Lutz JA, Grigoroiu M, Brian E, Seguin-Givelet A. Unplanned procedures during thoracoscopic segmentectomies. Ann Thorac Surg 2017;104:1710-7. https://doi.org/10.1016/j.athoracsur.2017.05.081
  18. Shimizu K, Nakano T, Kamiyoshihara M, Takeyoshi I. Segmentectomy guided by three-dimensional computed tomography angiography and bronchography. Interact Cardiovasc Thorac Surg 2012;15:194-6. https://doi.org/10.1093/icvts/ivs202
  19. Ikeda N, Yoshimura A, Hagiwara M, Akata S, Saji H. Three dimensional computed tomography lung modeling is useful in simulation and navigation of lung cancer surgery. Ann Thorac Cardiovasc Surg 2013;19:1-5. https://doi.org/10.5761/atcs.ra.12.02174
  20. Akiba T. Utility of three-dimensional computed tomography in general thoracic surgery. Gen Thorac Cardiovasc Surg 2013;61:676-84. https://doi.org/10.1007/s11748-013-0336-z
  21. Oizumi H, Kanauchi N, Kato H, et al. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases. J Thorac Cardiovasc Surg 2011;141:678-82. https://doi.org/10.1016/j.jtcvs.2010.08.027
  22. Chen-Yoshikawa TF, Date H. Update on three-dimensional image reconstruction for preoperative simulation in thoracic surgery. J Thorac Dis 2016;8(Suppl 3):S295-301.
  23. Sato M, Murayama T, Nakajima J. Concepts and techniques: how to determine and identify the appropriate target segment in anatomical pulmonary segmentectomy? J Thorac Dis 2019;11:972-86. https://doi.org/10.21037/jtd.2019.02.83
  24. Sato M, Murayama T, Nakajima J. Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP). J Thorac Dis 2016;8(Suppl 9):S716-30. https://doi.org/10.21037/jtd.2016.09.56
  25. Wells FC, Milstein BB. Thoracic surgical techniques. London: Bailliere Tindall; 1990.
  26. Tsubota N. An improved method for distinguishing the intersegmental plane of the lung. Surg Today 2000;30:963-4. https://doi.org/10.1007/s005950070056
  27. Okada M, Mimura T, Ikegaki J, Katoh H, Itoh H, Tsubota N. A novel video-assisted anatomic segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg 2007;133:753-8. https://doi.org/10.1016/j.jtcvs.2006.11.005
  28. Oizumi H, Kato H, Endoh M, Inoue T, Watarai H, Sadahiro M. Techniques to define segmental anatomy during segmentectomy. Ann Cardiothorac Surg 2014;3:170-5.
  29. Kamiyoshihara M, Kakegawa S, Morishita Y. Convenient and im-proved method to distinguish the intersegmental plane in pulmonary segmentectomy using a butterfly needle. Ann Thorac Surg 2007;83: 1913-4. https://doi.org/10.1016/j.athoracsur.2006.06.052
  30. Misaki N, Chang SS, Gotoh M, Yamamoto Y, Satoh K, Yokomise H. A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg 2009;138:613-8. https://doi.org/10.1016/j.jtcvs.2009.01.003
  31. Misaki N, Chang SS, Igai H, Tarumi S, Gotoh M, Yokomise H. New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system. J Thorac Cardiovasc Surg 2010;140:752-6. https://doi.org/10.1016/j.jtcvs.2010.07.020
  32. Tarumi S, Misaki N, Kasai Y, Chang SS, Go T, Yokomise H. Clinical trial of video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green. Eur J Cardiothorac Surg 2014; 46:112-5. https://doi.org/10.1093/ejcts/ezt565
  33. Ito A, Takao M, Shimamoto A, Shimpo H. Prolonged intravenous indocyanine green visualization by temporary pulmonary vein clamping: real-time intraoperative fluorescence image guide for thoracoscopic anatomical segmentectomy. Eur J Cardiothorac Surg 2017;52: 1225-6. https://doi.org/10.1093/ejcts/ezx233
  34. Sato M, Kuwata T, Yamanashi K, et al. Safety and reproducibility of virtual-assisted lung mapping: a multicentre study in Japan. Eur J Cardiothorac Surg 2017;51:861-8.
  35. Ohtsuka T, Goto T, Anraku M, et al. Dissection of lung parenchyma using electrocautery is a safe and acceptable method for anatomical sublobar resection. J Cardiothorac Surg 2012;7:42. https://doi.org/10.1186/1749-8090-7-42
  36. Chen X, Jin R, Xiang J, et al. Methods for dissecting intersegmental planes in segmentectomy: a randomized controlled trial. Ann Thorac Surg 2020;110:258-64. https://doi.org/10.1016/j.athoracsur.2020.02.013