A case of thoracoscopic medial basal segmentectomy

Abstract

HighlightsMedial basal segmentectomy is uncommon procedure.It is difficult to perform the procedure because of anatomical variations.This is a rare report of thoracoscopic medial basal segmentectomy.

Lung segments from anatomy to surgery

“…The intersegmental planes can be identified quickly in the vast majority (88-95.6%) of cases; the contrast fluorescence is maximum after 20-30 seconds [27,29,66]. In most cases the intersegmental plane disappears within two minutes [27,29], which should be enough time for the surgeon to mark it by electrocoagulation [7].…”

“…In contrast, the demarcation line on the lung surface helps when the peripheral part of the intersegmental plane is prepared [19,20]. The demarcation line is created on the basis of the previously mentioned difference between segment deflation and inflation, and it is marked by electrocoagulation so the activity does not have to be repeated [7]. For an upper lobe segmentectomy, the middle plane is identified first and then the peripheral one [74].…”

“…Segmentectomy is also associated with low postoperative mortality [18,32,34,42,69]. To prevent air leakage, continuous over-and-over suturing should be instituted; and to prevent later leakage, sealing materials such as polyglycolic acid felt can be used [7,14].…”

Uniportal thoracoscopic segmentectomy of medial-basal segment (S7) and its variants

“…Cases of thoracoscopic medial-basal segment (S7) segmentectomy are rarely reported, 1 , 2 , 3 possibly because S7 is the smallest 2 and deepest segment of the lungs. The advent of computed tomography screening has increased the detection of ground-glass opacity (GGO) nodules, 4 which are commonly found in S7.…”

“…The advent of computed tomography screening has increased the detection of ground-glass opacity (GGO) nodules, 4 which are commonly found in S7. Currently, only 2 publications 1 , 2 have described the technical details of 3-port or 4-port thoracoscopic S7 segmentectomy, and there is still no specific treatment for some anatomic variations of S7. We introduce step by step our uniportal thoracoscopic S7 segmentectomy and S7b sub-segmentectomy, and discuss the surgical treatment principles for all S7 variants.…”