Preoperative (3-dimensional) computed tomography lung reconstruction before anatomic segmentectomy or lobectomy for stage I non–small cell lung cancer

Chan, Ernest G.; Landreneau, James R.; Schuchert, Matthew J.; Odell, David D.; Gu, Suicheng; Pu, Jiantao; Luketich, James D.; Landreneau, Rodney J.

doi:10.1016/j.jtcvs.2015.06.051

Cited by 70 publications

(58 citation statements)

References 16 publications

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“…Now, several centers are exploring the reconstruction of the interface between the pulmonary segments, and have a preliminary implementation (12).…”

Section: Identification Of Surgical Margins and Segmental Resection Amentioning

confidence: 99%

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Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy

Wen

et al. 2016

J. Thorac. Dis.

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“…Now, several centers are exploring the reconstruction of the interface between the pulmonary segments, and have a preliminary implementation (12).…”

Section: Identification Of Surgical Margins and Segmental Resection Amentioning

confidence: 99%

“…demonstrate the segmental structures, reveal the anatomical variations and locate the pulmonary nodule (10)(11)(12). Preoperative simulation on 3D images is beneficial to remove the targeted segments accurately, reduce the surgical difficulty and shorten the learning curve.…”

mentioning

confidence: 99%

Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy

Wen

et al. 2016

J. Thorac. Dis.

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“…The 3-D images were created and manipulated during surgery. Thus, we performed the operations while comparing and contrasting the simulation under real-time conditions (10,11,22). We think that perceiving the anatomical relationship between the tumor and neighboring structures is important.…”

Section: Indication For Segmentectomymentioning

confidence: 99%

Determination of the intersegmental plane using the slip-knot method

Endoh¹,

Oizumi²,

Kato³

et al. 2018

J. Thorac. Dis.

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Background: Visualization of intersegmental planes in the lung is desirable for precise anatomical lung segmentectomy. We developed the slip-knot method for creating inflation-deflation lines. This study aimed to assess relevant data for thoracoscopic segmentectomy performed using this method. Methods: In the slip-knot method, the objective segmental bronchus is looped with a monofilament thread.One end of the thread is then pulled during temporary bilateral ventilation, causing the knot to slip toward the bronchus. Thereafter, bronchial ligation is tightened to block the outflow of segmental air, ensuring that the segment remains expanded while the other reserved segments collapse on resumption of unilateral ventilation. Data from 221 patients who underwent thoracoscopic pulmonary segmentectomy between 2010 and 2016 were analyzed. Results: A total of 147 patients (67%) were indicated for the slip-knot method, and 74 cases (33%) were non-adaptive cases. Ninety six percent of 147 cases were well adapted to the slip-knot method, which allowed us to obtain good inflation-deflation line images to determine the intersegmental plane. The mean operative time was 171±51 min (range, 71-367 min). The mean duration of chest tube insertion was 1.5±1.2 days (range, 1-7 days). Three cases (2.0%) had prolonged air-leakage and one (0.7%) case had readmission for late air-leakage. Conclusions: Our method enables determination of anatomical intersegmental planes using only one monofilament thread, thus facilitating thoracoscopic pulmonary anatomical segmentectomy.

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“…The use of traditional CT is rapidly being replaced by multi-detector CT to facilitate visualization of the anatomy on the basis of 3-D imaging. Therefore, there are some published papers that report the use of 3-D CT to view pulmonary vasculature and parenchymal reconstruction preoperatively (17)(18)(19)(20). Precise identification and division of the appropriate subsegmental veins is required for VATS subsegmentectomy.…”

Section: Technical Aspects Of Vats Subsegmentectomymentioning

confidence: 99%

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

et al. 2017

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Segmentectomy has been widely performed as one of the types of limited resections that are performed for the resection of small-sized lung nodules. Video-assisted thoracoscopic surgery has also been in demand as a minimally invasive surgery. Subsegmentectomy is a much more limited resection than segmentectomy, but the technique is complex because it requires keen anatomical identification of small pulmonary structures. Therefore, there has been little reported about subsegmentectomy in medical literature. The recent development of computed tomography is remarkable, and some reports describe three-dimensional computed tomography as providing useful information because it assists surgeons in the performance of thoracoscopic anatomical subsegmentectomy. The creation of an intersubsegmental line is a key process in subsegmentectomy, therefore, some methods have been reported. We have safely and accurately performed some video-assisted thoracoscopic subsegmentectomies for small-sized lung tumors, using the three-dimensional computed tomography simulation and creating the intersubsegmental line with the inflation-deflation technique. In this article, we describe the recent techniques and roles of video-assisted thoracoscopic subsegmentectomy, and offer prospects for this procedure with our clinical data. more anatomically detailed resection that can involve the dissection of hilar lymph nodes attached to the segment containing the tumor. Moreover, the oncological outcomes of segmentectomy in a propensity-matched study were comparable to those of lobectomy for patients with earlystage non-small cell lung cancer (6). Segmentectomy has thus become widely used worldwide (1). While wedge resection has been applied to smaller lung nodules located in peripheral parenchyma, segmentectomy has been applied to small-sized lung nodules that show not only GGOs, but also solid appearances located in deep parenchyma. Recent developed CT enabled the detection of small-sized pulmonary nodules containing GGO component. For such smaller pulmonary nodules, especially located in the deep parenchyma, subsegmentectomy may be an alternative procedure; this is because it is difficult to perform a wedge resection for hilum nodules located in the deep parenchyma and segmentectomy may be an excessive resection for appropriate surgical margins.The role of subsegmentectomy is therefore considered as an intermediate procedure between wedge resection and segmentectomy. Consequently, we have concluded that the best indications for subsegmentectomy are as follows: (I) lung tumors of indeterminate nature, but considered suspicious for malignancy; (II) planned resection of a cT1aN0M0 primary lung cancer tumor less than 2 cm in diameter, with a GGO ratio of greater than 80% by highresolution CT, in patients with good pulmonary function who are able to tolerate lobectomy ( Figure 1A,B,C); (III) compromised resection in patients who are considered to be poor candidates for lobectomy due to limited cardiopulmonary reserve or other organ failure; (...

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Preoperative (3-dimensional) computed tomography lung reconstruction before anatomic segmentectomy or lobectomy for stage I non–small cell lung cancer

Cited by 70 publications

References 16 publications

Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy

Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy

Determination of the intersegmental plane using the slip-knot method

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

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