How to identify intersegmental planes in performing sublobar anatomical resections

Nex, Giulia; Schiavone, Marcella; Palma, Angela De; Quercia, Rosatea; Brascia, Debora; Iaco, Giulia De; Signore, Francesca Del; Panza, Teodora; Marulli, Giuseppe

doi:10.21037/asvide.2020.164

Cited by 5 publications

(5 citation statements)

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“…The uniform, solid coagulation layer caused by sealing may also be unfavorable for recognization of the ISD. Compared with stapling, the inferiority of energy devices mainly include more complex procedures, increased risk of air leakage; 22–25 and dependence on clear and persistent ISD. Therefore, an appropriate combination is believed to be better than alone 9,11 …”

Section: Discussionmentioning

confidence: 99%

Division of the intersegmental demarcation using the “modified hand‐tearing method” is safe and feasible in thoracoscopic anatomical segmentectomy

Feng

et al. 2022

Thoracic Cancer

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Background: The accurate and safe division of the intersegmental demarcation (ISD) is critical and challenging during thoracoscopic anatomical segmentectomy. Here, we provide an improved technique which emphasizes the application of an electric hook and blunt division of ISD. The technique is termed as the "modified hand-tearing method" (MHT method) with combined application of an electric hook and staplers. The study aimed to review the outcomes of patients who underwent thoracoscopic anatomical segmentectomy, with or without the MHT method in our institute and assess its feasibility and safety. In addition, we compared the feasibility between video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) using the MHT method. Methods: From 2018 July to 2021 June, we retrospectively analyzed 701 patients who underwent segmentectomy. Using propensity score matching, data of two well-matched pairs of 276 cases in the MHT method and non-MHT method groups, and two wellmatched pairs of 40 cases in the VATS and RATS subgroups were obtained. The clinical and perioperative characteristics of patients were compared between groups. Results: Compared with the non-MHT method group, the MHT method group had shorter operation time and shorter postoperative hospital stay. Period of chest tube drainage and postoperative total drainage and postoperative complications had no between-group difference. Compared with VATS, the RATS subgroup had less intraoperative bleeding and shorter postoperative hospital stay. Conclusion: Division of ISD using the MHT method has advantages in precision and ease of operation, so it has the potential to become a feasible and effective method for thoracoscopic anatomical segmentectomy.

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Section: Discussionmentioning

confidence: 99%

Division of the intersegmental demarcation using the “modified hand‐tearing method” is safe and feasible in thoracoscopic anatomical segmentectomy

Feng

et al. 2022

Thoracic Cancer

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“…For example, during surgery, if the intersegmental plane is directly tailored by staplers after ligating the arterial and bronchi of the target segment, it may result in an insufficient surgical margin. [14][15][16] (5) Erroneous dissection of intersegmental veins and intersubsegmental veins can lead to postoperative pulmonary congestion or hemoptysis. 17 The analysis of image anatomy has revealed the consistent presence of venous drainage between segments and subsegments.…”

Section: Drainage Patterns Of Three Sub-branchesmentioning

confidence: 99%

Three‐dimensional imaging anatomical research and clinical implications of V¹ ⁺²d in the left upper lung

Liao,

Xu,

et al. 2023

Thoracic Cancer

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Background: To investigate the distribution pattern of V1+2d in the left superior pulmonary vein and its clinical significance.Methods: A retrospective analysis was conducted using three‐dimensional computed tomographic bronchography and angiography (3D‐CTBA) data from 500 lung cancer patients. Statistical analyses were performed to evaluate the incidence and drainage patterns of the three sub‐branches of V1+2d, namely V1+2d1, V1+2d2 and V1+2d3. Furthermore, clinical data from 10 patients' lesions involving V1+2d were reviewed to illustrate the impact of adjacency to V1+2d on the surgical approach.Results: The incidences of V1+2d1, V1+2d2 and V1+2d3 were 100%, 76.4% and 100% respectively. The relative interlobar distribution sizes of B3a and B1+2c and the left upper division (LUD) vein type influenced the incidence of V1+2d2 (p < 0.05; p < 0.001). V1+2d2 predominantly occurred in B3a = B1+2c and B1+2c > B3a patterns. V1+2d2 was entirely absent in the B3a > B1+2c pattern. V1+2d2 exhibited a higher incidence in both the central vein (CV) type and the noncentral vein (NCV) type when compared to the semi‐central vein (SCV) type (100% vs. 100% vs. 64.8%). The most prevalent venous drainage pattern was the three sub‐branches of V1+2d constituting a major trunk to drain (41.2%). All 10 cases with lesions involving V1+2d successfully underwent sublobar resection with no complications, and the surgical margin was ≥2 cm.Conclusion: The three sub‐branches of V1+2d exhibit a high incidence with diverse distribution patterns, yet a discernible pattern exists. For inter‐ or multi‐intersegmental nodules involving V1+2d, combined segmentectomy and subsegmentectomy or combined subsegmentectomy can ensure the safe margin.

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“…Pseudo-tumors combined with a sponge and porcine lungs were utilized in this preclinical study based on the methods used in previous studies attempting percutaneous or transbronchial tumor localization using ICG (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

A novel system for analyzing indocyanine green (ICG) fluorescence spectra enables deeper lung tumor localization during thoracoscopic surgery

Chiba¹,

Ebihara²,

Shiiya³

et al. 2022

J Thorac Dis

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Background: Palpation of tumors during thoracoscopic surgery remains difficult, and identification of deep-seated tumors may be impossible. This preclinical study investigated the usefulness of a novel indocyanine green (ICG) fluorescence spectroscopy system for tumor localization.Methods: ICG was diluted to 5.0×10 −2 mg/mL in fetal bovine serum (FBS) and mixed with silicone resin to prepare pseudo-tumors. Sponges of different densities and a porcine lung were placed on top of the pseudo-tumors, which were examined using a novel fluorescence spectroscopy system and a near-infrared (NIR) camera. Spectra were measured for different sponge and lung thicknesses, and the lung spectra were measured during both inflation and deflation.Results: The fluorescence spectroscopy system was able to identify tumors at depths ≥15 mm, while the NIR system was not. The spectroscopy system also detected tumors at greater depths when the density of the intervening material was lower. Depending on the density and thickness of the intervening material, the system could detect spectra as deep as 40 mm for sponges and 30 mm for lungs.Conclusions: This new fluorescence spectroscopy system can be used to identify lung tumors up to a depth of 30 mm in experiments using pseudo-tumors and a porcine lung, which may aid in tumor identification during thoracoscopic surgery.

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How to identify intersegmental planes in performing sublobar anatomical resections

Cited by 5 publications

References 0 publications

Division of the intersegmental demarcation using the “modified hand‐tearing method” is safe and feasible in thoracoscopic anatomical segmentectomy

Division of the intersegmental demarcation using the “modified hand‐tearing method” is safe and feasible in thoracoscopic anatomical segmentectomy

Three‐dimensional imaging anatomical research and clinical implications of V¹ ⁺²d in the left upper lung

A novel system for analyzing indocyanine green (ICG) fluorescence spectra enables deeper lung tumor localization during thoracoscopic surgery

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How to identify intersegmental planes in performing sublobar anatomical resections

Cited by 5 publications

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Division of the intersegmental demarcation using the “modified hand‐tearing method” is safe and feasible in thoracoscopic anatomical segmentectomy

Division of the intersegmental demarcation using the “modified hand‐tearing method” is safe and feasible in thoracoscopic anatomical segmentectomy

Three‐dimensional imaging anatomical research and clinical implications of V1 +2d in the left upper lung

A novel system for analyzing indocyanine green (ICG) fluorescence spectra enables deeper lung tumor localization during thoracoscopic surgery

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Three‐dimensional imaging anatomical research and clinical implications of V¹ ⁺²d in the left upper lung