Methods for Dissecting Intersegmental Planes in Segmentectomy: A Randomized Controlled Trial

Chen, Xingshi; Jin, Runsen; Xiang, Jie; Han, Dingpei; Zhang, Yajie; Li, Chengqiang; Yang, Sheng; Wu, Han; Han, Yu; Yuan, Ye; Chen, Kai; Du, Hong; Hang, Junjie; Sihoe, Alan D. L.; Li, Hecheng

doi:10.1016/j.athoracsur.2020.02.013

Cited by 26 publications

(28 citation statements)

References 22 publications

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“…It was found that the staple group had much lower resistance to the pressure load. This aspect is surprising because in a study by Chen et al [14], the stapler was superior to the monopolar cutter. A conceivable cause could be that the staples tend to loosen and produce leakage if the parenchymatous bridge is wider.…”

Section: Discussionmentioning

confidence: 93%

Determination of initial airtightness after anatomical laser segmentectomy in an ex vivo model

et al. 2021

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If a pulmonary pathology can be removed by anatomical segmentectomy, the need for lobectomy is obviated. The procedure is considered oncologically equivalent and saves healthy lung tissue. In every segmentectomy, lung parenchyma must be transected in the intersegmental plane. Using an ex vivo model based on porcine lung, three transection techniques (monopolar cutter + suture, stapler, and Nd:YAG laser) are to be compared with respect to their initial airtightness. At an inspiratory ventilation pressure of 25 mbar, all three preparations were airtight. Upon further increase in ventilation pressure up to 40 mbar, the laser group performed best in terms of airtightness. Since thanks to its use of a laser fibre, this technique is particularly suitable for minimally invasive surgery; it should be further evaluated clinically for this indication in the future.

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Section: Discussionmentioning

confidence: 93%

Determination of initial airtightness after anatomical laser segmentectomy in an ex vivo model

et al. 2021

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“…After a systematic review of the abstract in each publication, 297 studies were excluded, and the full text of the other 19 studies was reviewed. After evaluation, six studies were eventually enrolled (11)(12)(13)(14)(15)(16), including five retrospective observational studies and one RCT, with a total of 385 patients. The single-arm research studies and studies with no description of the comparison of surgical instruments were excluded.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The electrocautery group was taken as the experimental group, and the stapler group was regarded as the control group in our analysis. Five studies focusing on the incidence of air leaks presented that there were 23 in 156 patients (14.7%) suffering from air leaks in the electrocautery group and 7 in 180 patients (3.9%) suffering from air leaks in the stapler group (12)(13)(14)(15)(16). The incidence of postoperative air leaks in the electrocautery group was higher than that in the stapler group [OR: 3.91, 95% CI (1.64, 9.35), P = 0.002] (Figure 2).…”

Section: Primary Outcome Measuresmentioning

confidence: 99%

“…The result was confirmative with high heterogeneity (I 2 = 77%, P = 0.004). Four studies (12,13,15,16) including 288 patients focused on the duration of the drainage tube and showed no significant difference between the two groups [MD = 0.36, 95% CI (−0.27, 0.98), P = 0.26]. The details of the above and other outcomes are summarized in Table 3.…”

Section: Secondary Outcome Measuresmentioning

confidence: 99%

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Electrocautery vs. Stapler in Comparing Safety for Segmentectomy of Lung Cancer: A Meta-Analysis

Zhang

Jiang

et al. 2021

Front. Surg.

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Background: Electrocautery and staplers are regarded as the two most common surgical instruments for dissecting the intersegmental plane in segmentectomy. We performed a meta-analysis to compare electrocautery and staplers in terms of their safety and effects.Methods: A systematic search strategy was performed using PubMed, and the retrieval time was up to April 1, 2020. Odds ratio (OR) and mean differences (MDs) with 95% CI were applied to determine the effectiveness of dichotomous or continuous variables, respectively.Results: Six studies including 385 patients were included. The electrocautery had a higher incidence rate of postoperative complication [OR= 1.92, 95% CI (1.12, 3.28), P = 0.02)] and air leak [OR: 3.91, 95% CI (1.64, 9.35), P = 0.002)]. No significant difference was found in the comparison of surgery time, blood loss, and duration of tube days or hospitality days.Conclusions: Our study indicated that patients under segmentectomy were associated with better safety by using stapler than electrocautery in the reduction of postoperative complications.

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“…However, it is possible that their use may lead to more postoperative complications, such as prolonged air leakage or bronchopleural fistula [ 35 ]. Recently, a randomized controlled trial reported a higher incidence of postoperative complications (e.g., air leakage) in the electrocautery group, while no difference was found in the loss of lung function [ 36 ]. However, there remain concerns that the effect of preserving lung function would be reduced by lung-folding involving multiple stapling actions when performing thoracoscopic complex segmentectomy.…”

Section: Identification Of the Intersegmental Planementioning

confidence: 99%

Video-Assisted Thoracic Surgery Segmentectomy

2021

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Although lobectomy remains the gold-standard surgical treatment for non–small-cell lung cancer, the frequency of thoracoscopic segmentectomy is increasing. Multiple factors must be considered in the choice of the procedure, ranging from adequate surgical planning or simulation, tumor localization, and identification of the intersegmental plane to severing the intersegmental plane to achieve an oncologically safe surgical margin with no or minimal manual palpation and different landmarks. In this article, we present an overview of methods for each procedural step of thoracoscopic segmentectomy, from preoperative planning to division of the intersegmental plane.

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Methods for Dissecting Intersegmental Planes in Segmentectomy: A Randomized Controlled Trial

Cited by 26 publications

References 22 publications

Determination of initial airtightness after anatomical laser segmentectomy in an ex vivo model

Determination of initial airtightness after anatomical laser segmentectomy in an ex vivo model

Electrocautery vs. Stapler in Comparing Safety for Segmentectomy of Lung Cancer: A Meta-Analysis

Video-Assisted Thoracic Surgery Segmentectomy

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