Management of Intersegmental Plane on Pulmonary Segmentectomy Concerning Postoperative Complications

Saito, Hajime; Konno, Hayato; Atari, Maiko; Kurihara, Nobuyasu; Fujishima, Satoshi; Sato, Yusuke; Motoyama, Satoru; Minamiya, Yoshihiro

doi:10.1016/j.athoracsur.2017.01.014

Cited by 15 publications

(24 citation statements)

References 17 publications

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“…Saito et al (13) compared postoperative pulmonary function and complications between mesh cover and pleural suture groups. They demonstrated that use of a mesh cover or pleural suture was the only factor independently related to pulmonary complications such as prolonged or delayed air leak after pulmonary segmentectomy.…”

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confidence: 99%

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

et al. 2018

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Background: Division of intersegmental planes is one of the important practical issues for segmentectomy to obtain feasible outcomes without relapse for clinical stage I non-small cell lung cancer. Almost all surgeons perform this procedure using a stapler. However, division of intersegmental planes for segmentectomy can also be performed by electrocautery. In this article, we demonstrate the merits and drawbacks of division of the intersegmental plane by electrocautery for segmentectomy. Methods: Of those 125 patients who underwent segmentectomy with clinical stage I primary lung cancer, we compared cautery cases (n=50) with stapler cases (n=75). The cautery group included 29 cases (58.0%) with partial use of a staple at the end of division. Results: Operative time was significantly longer in cautery cases (281±72 min) than stapler in cases (235±86 min; P=0.003). No difference in the duration of chest tube placement was evident between cautery (3.0±3.0 days) and stapler groups (2.8±1.7 days; P=0.613). However, delayed air leakage occurred significantly more frequently in cautery cases (14.0%) than in stapler cases (4.0%; P=0.048). Five-year overall survival (OS) in clinical stage I was 94.7% in cautery cases and 80.5% in stapler cases (log-rank P=0.047). Five-year disease-free survival (DFS) was 80.0% and 71.3%, respectively (log-rank P=0.075). Conclusions: The merits of cautery division include the ability to achieve meticulous division of the intersegmental plane and good preservation of the shape of residual segments. Conversely, the drawbacks include prolonged air leakage. Pleural suture or closure of residual segments may be useful to prevent delayed air leakage.

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confidence: 99%

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

et al. 2018

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“…We chose electrocautery combined with staplers for the division of the S 8 and S 9 intersegmental plane. Electrocautery has been shown to be useful for dissecting the intersegmental plane (8,9). In our opinion, combination of both manners for the division may be ideal in the complex type of segmentectomy.…”

Section: Discussionmentioning

confidence: 87%

Microinvasive segmentectomy: a case of video-assisted thoracic surgery left S9+10 segmentectomy

Yuan

2018

J. Thorac. Dis.

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“…According to previous reports, pulmonary complications after pulmonary segmentectomy ranged from 6.6% to 17.3% (4,19). Additionally, persistent air leak or delayed pneumothorax after segmentectomy is prevalent and increases surgical morbidity (20). Previous reports also suggested that the incidence of delayed pneumothorax ranged from 2.2% to 18% (20,21).…”

Section: Discussionmentioning

confidence: 99%

Management of the inter-segmental plane using the “Combined Dimensional Reduction Method” is safe and viable in uniport video-assisted thoracoscopic pulmonary segmentectomy

Zheng¹,

Xu²,

Fu³

et al. 2019

Transl. Lung Cancer Res.

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Background: The management of the intersegmental plane (ISP) is challenging during uniport videoassisted thoracoscopic (VATS) pulmonary segmentectomy. Staplers and electrocautery have been used extensively in ISP management. However, both of them have their respective drawbacks. Currently, we have provided a revised technique termed as "Combined Dimensional Reduction Method" (CDR method), for managing the ISP with combined application of ultrasonic scalpel and staplers. The study aimed to review the outcomes of patients who underwent uniport VATS segmentectomy with or without the CDR method in our institute and assess the feasibility and safety of the CDR method.Methods: From March 2017 to February 2018, 220 patients who underwent uniport VATS segmentectomy were retrospectively reviewed. By using IQQA software, pulmonary structures were reconstructed as three-dimensional (3D) images, making the targeted structures could be identified preoperatively. For the management of the ISP, in the CDR group, we firstly used the ultrasonic scalpel to trim the 3D pulmonary structure along the intersegmental demarcation, making the remaining targeted parenchyma both sufficiently thin enough and located on a 2D plane; thus, enabling easy use of staplers in managing ISP. Whereas, in the non-CDR group, we only use the staplers to manage the ISPs. The clinical characteristics, complications, and postoperative pulmonary functions were compared between the two groups.Results: Propensity score analysis generated 2 well-matched pairs of 71 patients in CDR and non-CDR groups. There was no 30-day postoperative death or readmission in either group. The CDR group was significantly associated with the shorter operative time (178.3±35.8 vs. 209.2±28.7 min) (P=0.031) and postoperative stay (4.5±2.3 vs. 5.7±4.2 days) (P=0.041), compared to the non-CDR group. Moreover, no significant difference was observed in blood loss, a period of chest tube drainage, a period of ultrafine tube drainage, and postoperative pulmonary complications between the two groups. Moreover, the recovery rate of postoperative forced expiratory volume in 1 second (FEV1) or vital capacity (VC) at 1 and 3 months after segmentectomy was comparable between them. Conclusions:The CDR method could make segmentectomy easier and more accurate, and therefore has the potential to be a viable and effective technique for uniport VATS pulmonary segmentectomy.

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Management of Intersegmental Plane on Pulmonary Segmentectomy Concerning Postoperative Complications

Cited by 15 publications

References 17 publications

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

Microinvasive segmentectomy: a case of video-assisted thoracic surgery left S9+10 segmentectomy

Management of the inter-segmental plane using the “Combined Dimensional Reduction Method” is safe and viable in uniport video-assisted thoracoscopic pulmonary segmentectomy

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