Individualized dorsal basal segment (S10) resection using intersegmental veins as the landmark

Abstract

OBJECTIVES The individualized thoracoscopic dorsal basal (S10) resection remains one of the most challenging procedures. Our goal was to detail the role of intersegmental veins (inter-SVs) in facilitating such a complex operation and evaluate its safety and efficacy. METHODS We retrospectively reviewed patients who underwent S10 or S10 plus an adjacent segment or subsegment resection (individualized S10) from January 2015 through September 2020. Individualized S10 resections were conducted for nodules of 2 cm or less with a ground-glass opacity evident in thin-slice computed tomography. A simplified method of using inter-SVs as the landmark in surgical planning and segmentectomy was described. The efficacy and safety of this technique were also evaluated in comparison with those aspects of the lower lobectomy. RESULTS In total, 46 patients who underwent individualized S10 through an inferior pulmonary ligament approach were included. All patients received R0 resection with a surgical margin of 22.45 mm. No patient was converted to an extended resection such as an entire basal or lower lobar resection. Three patients whose situation was complicated with an air leak had non-urgent interventions. Comparable results were obtained between the segmental and lobar arms in terms of blood loss (49.13 vs 45.98 ml), postoperative hospital stay (4.96 vs 5.18 days) and persistent air leak (6.52% vs 4.01%). CONCLUSIONS A strategy guided by the inter-SVs permits one to tailor the surgical planning for S10 nodules without compromising the surgical margin. It could also facilitate target bronchial recognition and intersegmental plane division. However, long-term follow-up and large clinical studies are needed to further justify its clinical benefits.

A ‘true segmentectomy’ cannot be overemphasized especially in the complex setting

“…We would like to thank Gossot and Seguin-Givelet [ 1 ] for their helpful comments regarding our article describing the role of intersegmental veins as the landmark in individualized dorsal basal segment (S 10 ) resection [ 2 ]. They point out that surgical teams will theoretically and technically master any type of anatomic segmentectomies, especially in the complex settings.…”

“…Second, the location of a target nodule is sometimes ambiguous. The instance of intersegmental nodules [ 2 , 7 ] or deep-located nodules [ 8 ] within the pulmonary parenchyma is not rare. When segmentectomy is initially planned even with the guide of 3D-CTBA in these scenarios, it is of great value to accurately identifying hilar structures and appropriately handling intersegmental plane.…”