VATS segmentectomy: past, present, and future

Abstract

Video-assisted thoracoscopic surgery (VATS) has gradually been implemented in thoracic surgery, and the VATS approach has now been extended to technically challenging procedures, such as segmentectomy. The definition of VATS segmentectomy is changing over time, and the repertoire of segmentectomy is getting wider with increasing reports on atypical segmentectomy. VATS segmentectomy bears surgical, oncological, and technical advantages; however, there are still areas of controversy, particularly regarding oncological outcomes. The indication of VATS segmentectomy is diverse and is used for treating lung cancer, metastatic lung tumors, or a variety of nonmalignant diseases. It is particularly valuable for the lung-sparing resection of deeply located small nodules or repeated surgery for multiple lung lesions. VATS segmentectomy requires a thorough analysis of segmental anatomy and a tailored preoperative planning with the assessment of surgical margins. Technical challenges include intraoperative navigation, methods to identify and dissect the intersegmental plane, and the prevention of air leakage. This review will discuss the present state of VATS segmentectomy, with a focus on past studies, current indications and techniques, and future view.

Is the near‐infrared fluorescence imaging with intravenous indocyanine green method for identifying the intersegmental plane concordant with the modified inflation‐deflation method in lung segmentectomy?

“…Thoracoscopic segmentectomy may be used as a mini‐invasive procedure that represents significant advancement in thoracic surgery technology, and is increasingly being utilized as a more prominent option for the treatment of early‐stage lung cancer, owing to the small surgical incision and resection range. However, the most commonly performed segmentectomies are lingular, left upper lobectomy, superior and basilar segmentectomy, that are simple segments.…”

“…With the development of current imaging technology, more and more early stage lung cancer is being detected. Therefore, precise resection of small pulmonary nodules has become an opportunity and challenge for contemporary thoracic surgeons . Segmentectomy is increasingly becoming a popular technique for the treatment of early stage lung cancer as it combines equivalent oncologic requirements and greater preservation of lung function.…”

Uniportal video‐assisted thoracoscopic left S4 anatomical segmentectomy

“…In this patient, the GGO was located in the internal 1/3 part of the fissure, thus wedge resection was infeasible. VATS segmentectomy is particularly valuable for the lung‐sparing resection of deeply located small nodules, as in this case, and thus it was employed as treatment for this patient . In general, lingular (S4 + S5) segmentectomy is used for SPLs in the lingular segment .…”

“…VATS segmentectomy is particularly valuable for the lung-sparing resection of deeply located small nodules, as in this case, and thus it was employed as treatment for this patient. 9 In general, lingular (S4 + S5) segmentectomy is used for SPLs in the lingular segment. 7 Yamashita et al reported the use of S3 + S4 segmentectomy and S3b + S4 segmentectomy for the treatment of tumors located between the upper division and lingular segment.…”

Short‐term outcomes of typical versus atypical lung segmentectomy by minimally invasive surgeries

“…Atypical segmentectomy includes resection of individual segments of the upper lobe, middle lobe, or basilar segments. Atypical segmentectomy may be technically feasible but remains challenging due to its complications …”