Port-access thoracoscopic anatomical right anterior segmentectomy

Hiroyuki Oizumi, Hirohisa Kato, Makoto Endoh, Jun Suzuki, Hikaru Watarai, Katsuyuki Suzuki, Mitsuaki Sadahiro


Background: Thoracoscopic lung segmentectomy is a complicated and thus controversial procedure. The term “segment” comprises several genres. Each segment or subsegment is defined anatomically as the lung area for ventilation of the bronchial branches. Human lungs consist of 18 segments as well as block segments such as lingular or basal segments. Therefore, thoracoscopic lung segmentectomy includes various types of procedures.
Methods: We developed pulmonary segmentectomy method under three-dimensional multidetector computed tomography simulation and so far performed 248 port access thoracoscopic anatomic lung segmentectomies. Also we developed a slip-knot technique for creating the inflation-deflation line to delineate the intersegmental plane and used this method as standard since 2010. The intersegmental plane was identified using the intersegmental veins as landmarks and the demarcation between the resected (inflated) and preserved (collapsed) lungs.
Results: The success rate of segmentectomy performed under complete thoracoscopy was 99%. Minithoracotomy was required for two patients because of arterial bleeding. The chest tubes were left in place for 1-8 d (median duration, 1 d). There were no recurrences of the primary tumor in the curative-intent resection group patients for lung cancer treatment.
Conclusions: Thoracoscopic lung segmentectomy achieved by multidetector computed tomography for use in respective anatomical interpretation enabled precise parenchymal dissection. Our slip-knot technique facilitated the creation of inflation-deflation line under thoracoscopic surgery and shortened the surgical time consequently. Herein, we present the representative case of an 84-year-old man who underwent port-access anatomical resection of the anterior segment of right upper lobe (S3). In this patient, we used a vessel sealing system for cutting the vessels and dissecting the parenchyma.