Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: A report of 52 consecutive cases

Oizumi, Hiroyuki; Kanauchi, Naoki; Kato, Hirohisa; Endoh, Masao; Suzuki, Jun; Fukaya, Ken; Sadahiro, Mitsuaki

doi:10.1016/j.jtcvs.2010.08.027

Cited by 175 publications

(138 citation statements)

References 16 publications

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“…After using the above method to determine the nodules location, identify a safe margin and plan a surgical approach, according to the anatomic character of pulmonary bronchus and arteries, the bronchus and arteries of the targeted segment are identified and made out on 3D images ( Figure 1B) (11,15,16). The segmental vein that runs on the surfaces of the intersegments and collects venous blood of the adjacent segments is the natural boundary of the segments, which should be preserved during operation.…”

Section: Identification Of the Targeted Segmental Anatomic Structuresmentioning

confidence: 99%

“…Wrong division of the main intersegmental vein can cause postoperative hemoptysis. On 3D images, we could identify which intersegmental vein should be preserved and which intrasegmental veins could be divided (16), measure the closest distance between the nodule and the intersegmental vein, determine whether the targeted segment is cut adequately or not according to the requirement of the safe margins, and make the surgical plan. Researchers from both China and overseas have reported that 3D printing technology has been applied to guide segmentectomy.…”

Section: Identification Of the Targeted Segmental Anatomic Structuresmentioning

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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Section: Identification Of the Targeted Segmental Anatomic Structuresmentioning

confidence: 99%

Section: Identification Of the Targeted Segmental Anatomic Structuresmentioning

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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“…Before surgery, three-dimensional computed tomography images are established (15). The simulation images are used to identify: (I) the segmental arterial branches; (II) the intersegmental veins to be preserved; and (III) the venous branches in the affected segment to be divided.…”

Section: B a Cmentioning

confidence: 99%

How to demarcate intersegmental plane with resected-segments inflation method using the slip knot technique in thoracoscopic anatomic segmentectomy

et al. 2017

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Intersegmental demarcation line on the surface of the visceral pleura could not be found at thoracoscopic findings. The resected segments inflation (RSI) method has been reported as a useful technique for visualizing the intersegmental demarcation line during segmentectomy. Thoracoscopic anatomic segmentectomy is performed as follows: firstly, the pulmonary vein and artery of the segment planned for resection are dissected from the hilum in order to isolate the segmental bronchus located behind the pulmonary artery. Secondly, a monofilament non-absorbable suture is passed through the segmental bronchus, and a slip-knot is made outside the thorax. Thirdly, bilateral lung ventilation with pure oxygen is conducted. When the affected segment has inflated sufficiently, the slip knot suture is pulled and the segmental bronchus is ligated and collapse of the lung is made on reserved segments. Fourthly, as inflation of the affected segment and collapse of the reserved segments could be found, resection of intersegmental plane could be easily performed with the inflation-deflation line and the intersegmental pulmonary vein. If resected segmental bronchus could be identified, thoracoscopic segmentectomy with the slip-knot technique would be applicable. This slip-knot procedure is economical and is not need special instrument. RSI methodAir is sent to the objective segmental bronchus located at the center of the basic pulmonary structure. The affected segment is inflated and reserved segments are collapsed and an intersegmental plane could be identified. If this is visualized well, resection of intersegmental plane could be easily performed with the inflation-deflation line and the intersegmental pulmonary vein. The lung parenchyma that is undergoing dissection of the intersegmental plane shows changes of the color by containing the air, which serves as a landmark during dissection. This method is advantageous in that inflated segments enable identify the surgical margin from the tumor to the intersegmental plane in an air-filled condition (6).Several methods for sending air to the resected segments have been reported. They include the jet ventilation method (7,8), and the butterfly needle method (9,10). The butterfly needle method involves the risk of an air embolism due to possible entry of air into the vein neighboring the bronchus (11,12). In this paper, we demonstrated that a new slip knot technique to make intersegmental demarcation line during segentectomy. Slip knot techniqueWe have been using the RSI method to identify the intersegmental plane. In the past, bronchoscopy was used to send air to the objective bronchus. However, this technique is skillful and the inflated segments become an obstacle to perform a thoracoscopic procedure in narrow intrathoracic space. To resolve the problems, we developed the slip knot technique, and use this technique to perform thoracoscopic anatomic segmentectomy.The modified Roeder knot is a method of ligation that is employed for the slip knot technique (13). A 3-0 or 4...

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“…3DCT simulation provides useful information for thoracoscopic surgery (2,3). We previously reported on port-access thoracoscopic anatomic lung segmentectomy and subsegmentectomy using 3DCT simulation for small lung nodules (4,5). The use of CT is rapidly being replaced by multidetector CT to facilitate easier visualization of the anatomy using 3D images.…”

Section: Commentsmentioning

confidence: 99%

Port-access thoracoscopic bisubsegmentectomy of right upper lobe posterior and anterior segments

et al. 2017

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A 64-year-old woman was admitted to our hospital with a 16-mm non-solid tumor with pure ground-glass nodule (GGN) contents in the posterior segment near the anterior segment of her right upper lung lobe that was suspicious of adenocarcinoma in situ (AIS). Three-dimensional computed tomography (3DCT) simulation was performed to identify the subsegmental artery and vein pre-or intra-operatively.Port-access thoracoscopic bisubsegmentectomy of the right upper lobe was performed. A frozen section revealed AIS. The tumor size was 13 mm and the surgical margin from the tumor edge to cutting line was more than 20 mm. The surgical time was 191 minutes and bleeding was 101 mL. The chest tube duration was 3 days and the post-operative hospital stay was 6 days.

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Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: A report of 52 consecutive cases

Abstract: Thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation is a safe technique.

Cited by 175 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

How to demarcate intersegmental plane with resected-segments inflation method using the slip knot technique in thoracoscopic anatomic segmentectomy

Port-access thoracoscopic bisubsegmentectomy of right upper lobe posterior and anterior segments

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