Thoracoscopic Pulmonary Segmentectomy With Collateral Ventilation Method

Yao, Fei; Wu, Weibing; Zhu, Quan; Zhai, Rong; Xu, Xinfeng; Chen, Liang

doi:10.1016/j.athoracsur.2020.12.020

Cited by 23 publications

(14 citation statements)

References 15 publications

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“…8 Recently, Yao et al demonstrated the validity and accuracy of a collateral ventilation method for ISP identification, which provided the basis for our novel method. 25 When a lung segment is inflated by positive ventilation, the pressure gradient makes the gas flow through collateral pathways into the adjacent segments, which makes the targeted segment fully inflate. After resuming the OLV, the preserved segments gradually collapsed by the circulation and gaseous exchange, while the targeted segment was still in an inflated state, thus naturally demarcating an irregular and reliable inflationdeflation line, and this does not change over time.…”

Section: Discussionmentioning

confidence: 99%

Combination of nitrous oxide and the modified inflation‐deflation method for identifying the intersegmental plane in segmentectomy: A randomized controlled trial

et al. 2021

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Background During thoracoscopic segmentectomy, accurately and rapidly identifying the intersegmental plane (ISP) is of great importance. This study aimed to investigate the effect and safety of a nitrous oxide (N2O)/oxygen (O2) inspired mixture on the appearance time of the ISP (TISP) via the modified inflation‐deflation method. Methods A total of 65 participants who underwent segmentectomy were randomized into three groups: 75% N2O (n = 24), 50% N2O (n = 23) or 0% N2O (n = 18). The 75% N2O group received a gas mixture of N2O/O2 (Fio2 = 0.25), the 50% N2O group received N2O/O2 (Fio2 = 0.5), and the 0% N2O group received 100% oxygen during lung expansion. The appearance time of satisfactory and ideal planes was recorded. Furthermore, arterial blood gas at breathing room air, one‐lung ventilation (OLV) before lung expansion, 5 and 15 min after lung expansion were also recorded. Results TISP was significantly shorter in the 75% N2O group (320.2 ± 65.9 s) compared with that of the 50% N2O group (552.4 ± 88.9 s, p < 0.001) and the 0% N2O group (968.3 ± 85.5 s, p < 0.001), while the 50% N2O group was shorter than that of the 0% N2O group (p < 0.001). Arterial oxygenation was significantly improved in the 0% N2O group only after lung expansion, before which there were no differences in mean PaO2 values among groups. Conclusions The use of N2O in the inspired gas mixture during lung expansion is an applicable strategy to rapidly identify the ISP via the modified inflation‐deflation method without any adverse effect on OLV related arterial oxygenation during segmentectomy.

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Section: Discussionmentioning

confidence: 99%

Combination of nitrous oxide and the modified inflation‐deflation method for identifying the intersegmental plane in segmentectomy: A randomized controlled trial

et al. 2021

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“…A collateral ventilation method was used for delineating the intersegmental plane and subsequently resecting the target segment, as reported by a previous study ( 16 ). To reduce the postoperative air leak, staplers were used for transecting the intersegmental plane as early as possible.…”

Section: Methodsmentioning

confidence: 99%

Application of three-dimensional (3D) reconstruction in the treatment of video-assisted thoracoscopic complex segmentectomy of the lower lung lobe: A retrospective study

Wang

Wang²,

Zhang³

et al. 2022

Front. Surg.

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BackgroundAn increasing number of lung ground-glass nodules (GGNs) have been detected ever since low-dose computer tomography started growing in popularity. Three-dimensional (3D) reconstruction technology plays a critical role in lung resection, especially in segmentectomy. In this study, we explore the role of 3D reconstruction in thoracoscopic complex segmentectomy of lower lung lobe.MethodsA total of 97 patients who underwent complex segmentectomy of lower lung lobe from January 2021 to March 2022 were retrospectively analyzed. We divided these patients into a 3D group (n = 42) and a routine group (n = 55) based on preoperative 3D reconstruction or without this procedure. The demographics of patients and GGNs were collected and perioperative outcomes were compared between the two groups.ResultsAll of the baseline characteristics between the groups were comparable (all P > 0.05). There was no 30-day postoperative mortality and conversion in the two groups. The operation time of the 3D group was significantly shorter than that of the routine group (111.4 ± 20.8 min vs. 127.1 ± 32.3 min, P = 0.007). The number of stapler reloads during surgery in the 3D group was less than that in the routine group (9.0 ± 2.2 vs. 10.4 ± 2.6, P = 0.009). The rate of air leakage on postoperative days 1–3 was lower in the 3D group (11.9% vs. 30.9%, P = 0.027). In addition, the resection margins of all patients in the 3D group were adequate, while four patients in the routine group had inadequate resection margins, although there was no statistically significant difference (P = 0.131). Intraoperative blood loss, postoperative drainage, postoperative hospital stay, pneumonia/atelectasis, and hemoptysis were similar between the two groups.ConclusionsFor performing complex segmentectomy of the lower lung lobe, the procedure of 3D reconstruction may shorten the operation time, decrease the number of stapler reloads, prevent postoperative air leakage, and guarantee a safe surgical margin. Therefore, 3D reconstruction is recommended for complex segmentectomy of the lower lung lobe.

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“…Consequently, it is widely accepted by thoracic surgeons and known as the "modified inflation-deflation method" and becomes a base way for newly developed methods to compare. Yao et al evaluated the success rate of this method and grade the borderline according to the intelligibility and found that up to 95.2% of cases in the complex segmentectomy group and 97.6% in the simple segmentectomy group received a satisfactory demarcation for surgery (7).…”

Section: Inflation-deflation Methodsmentioning

confidence: 99%

Intraoperative Identification of the Intersegmental Plane: From the Beginning to the Future

Zhang

Jin

et al. 2022

Front. Surg.

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Segmentectomy has played a crucial role in the treatment of early-stage lung cancer after the publication of JCOG0802, which indicated that patients with small-sized peripheral non-small-cell lung cancer could receive better survival from segmentectomy than lobectomy despite a higher local recurrence. The intraoperative identification of the intersegmental plane ensures complete resection of the lesion with sufficient margin so that it is deemed as the critical part of segmentectomy. Diverse methods have been developed to acquire distinguishable and lasting borderline between segments, but none of them is proved perfect. In this review, we searched and classified these techniques that emerged from the beginning when segmentectomy was used for bronchiectasis until now. Comparisons between different ways in mechanisms, facility, and safety were made to depict a comprehensive landscape for surgeons to select fit one. Furthermore, we presented our vision for the future of intersegmental plane identification.

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Thoracoscopic Pulmonary Segmentectomy With Collateral Ventilation Method

Cited by 23 publications

References 15 publications

Combination of nitrous oxide and the modified inflation‐deflation method for identifying the intersegmental plane in segmentectomy: A randomized controlled trial

Combination of nitrous oxide and the modified inflation‐deflation method for identifying the intersegmental plane in segmentectomy: A randomized controlled trial

Application of three-dimensional (3D) reconstruction in the treatment of video-assisted thoracoscopic complex segmentectomy of the lower lung lobe: A retrospective study

Intraoperative Identification of the Intersegmental Plane: From the Beginning to the Future

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