Inferior Pulmonary Ligament Division May Be Unnecessary during Left Upper Lobectomy: Effects on Lung Volume, Bronchial Angle and Bronchial Tortuosity

Abstract

The benefits of dissecting inferior pulmonary ligament (IPL) during upper lobectomy using video-assisted thoracoscopic surgery (VATS) for early-stage lung cancer remains controversial. This study evaluates the effect of IPL dissection by comparing the lung volume, bronchial angle, and bronchial tortuosity of the left lower lobe (LLL) during VATS upper lobectomy. Medical records of all patients who underwent VATS left upper lobectomy for early-stage lung cancer were evaluated. Patients were divided into group P (preservation) and group D (dissection). Pre- and post-surgery lung volumes, bronchial angles (angle 1: axial angulation; angle 2: vertical angulation), and bronchial tortuosity (curvature index of the left main bronchus) were measured using computed tomography images for comparison. Forty patients were included in each group. Patient characteristics such as age, gender, body mass index, and smoking status, and preoperative lung volume, bronchial angles, and tortuosity were not significantly different between the two groups, and there was no statistically significant difference in the axial and vertical angulations; however, the change in pre- and postoperative bronchial tortuosity (0.03 ± 0.03 vs. 0.06 ± 0.03) and lung volume (−558.1 ± 410.0 mL vs. −736.3 ± 382.7 mL) showed a significant difference (p < 0.001 and p = 0.04, respectively). Preservation of IPLs during left upper lobectomy may be beneficial for LLL expansion and induces less movement and positional change in the left main bronchus.

Preservation vs. dissection of inferior pulmonary ligament for thoracoscopic upper lobectomy: a prospective randomized controlled trial

“…Pulmonary volumetry enables objective and accurate observation of postoperative lung re-expansion. Moon et al [ 17 ] demonstrated that Group D experienced greater postoperative lung volume loss after LUL compared to Group P. In contrast, our study did not find a significant difference in pre- and postoperative lung volume change between Group P and Group D for both the left and right sides. It is conceivable that mild residual bronchial distortion may not exert a substantial influence on the recovery of lung volume, as the recovery process is subject to numerous contributing factors.…”

Preservation vs. Dissection of Inferior Pulmonary Ligament for Thoracoscopic Upper Lobectomy: A Prospective Randomized Controlled Trial

“…Pulmonary volumetry is a non-invasive, easy, and fast measurement technique that uses 3D reconstruction software to analyze patient CT scans and calculate each patient's lung volume, enabling objective and accurate observation of postoperative lung re-expansion. Moon et al [17] showed that Group D had a higher postoperative lung volume loss after left upper lobectomy compared to Group P. In contrast, our study did not nd a signi cant difference in pre-and post-operative lung volume change between Group P and Group D for both the left and right side. It is possible that a mild residual bronchial distortion may not signi cantly impact the recovery of lung volume, as the recovery process is in uenced by numerous factors.…”

Does the division of the inferior pulmonary ligament in upper lobectomy result in improved short-term clinical outcomes and long-term survival?

“…Moon et al [ 6 ] retrospectively reviewed 80 patients who underwent VATS left upper lobectomy for early-stage lung cancer in the National Health Insurance Service database and 2 institutions in which a single surgeon was appointed to perform the surgery in each institution. There was no significant difference in the chest tube duration, change in left bronchial axial or vertical angulation.…”