Clinical application of VATS combined with 3D-CTBA in anatomical basal segmentectomy

Abstract

ObjectiveThis study aimed to summarize the clinical application experience of video-assisted thoracic surgery (VATS) combined with three-dimensional computed tomography-bronchography and angiography (3D-CTBA) in anatomical basal segmentectomy.MethodsClinical data of 42 patients who underwent bilateral lower sub-basal segmentectomy by VATS combined with 3D-CTBA in our hospital from January 2020 to June 2022 were retrospectively analyzed; the patients included 20 males and 22 females, with a median age of 48 (30–65) years. Combined with the preoperative enhanced CT and 3D-CTBA techniques to identify the altered bronchi, arteries, and veins during the operation, the anatomical resection of each basal segment of both lower lungs was completed through the fissure approach or inferior pulmonary vein approach.ResultsAll operations were successfully completed without conversion to thoracotomy or lobectomy. The median operation time was 125 (90–176) min, the median intraoperative blood loss was 15 (10–50) mL, the median postoperative thoracic drainage time was 3 (2–17) days, and the median postoperative hospital stay was 5 (3–20) days. The median number of resected lymph nodes was 6 (5–8). There was no in-hospital death. Postoperative pulmonary infection occurred in 1 case, lower extremity deep vein thrombosis (DVT) in 3 cases, pulmonary embolism in 1 case, and persistent air leakage in the chest in 5 cases, all of which were improved by conservative treatment. Two cases of pleural effusion after discharge were improved after ultrasound guided drainage. Postoperative pathology showed 31 cases of minimally invasive adenocarcinoma, 6 cases of adenocarcinoma in situ (AIS), 3 cases of severe atypical adenomatous hyperplasia (AAH), and 2 cases of other benign nodules. All cases were lymph node-negative.ConclusionVATS combined with 3D-CTBA is safe and feasible in anatomical basal segmentectomy; consequently, this approach should be promoted and applied in clinical work.

Application of Three-dimensional Reconstruction in Anatomical Right Lateral Basal (RS9) Segmentectomy

“…This strategy is an ideal way to verify the vessels or bronchi that are di cult to identify. [10] The vascular and bronchial branching patterns of RS7 have not been summarized because of its small volume and relative independence from RS9. However, when the bronchial and vascular branches of S7a and S7b straddle the inferior pulmonary vein (IPV), the structure of RS7 will be encountered rst when conducting RS9 segmentectomy through the inferior pulmonary ligament approach.…”

“…Postoperative atelectasis occurred in 2 cases (7.4%), pneumonia in 3 cases (11.1%), hemoptysis in 1 case (3.7%), and prolonged air leakage (> 7day) in 1 case (3.7%), all of which were improved after conservative treatment. The median postoperative drainage time was 5 (3)(4)(5)(6)(7)(8)(9)(10)(11) days, and the median length of postoperative hospital stay was 5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) days. Final pathologies of lesions included minimally invasive adenocarcinoma (MIA) in 21 cases (77.8%) and adenocarcinoma in situ (AIS) in 6 cases (22.2%)(Table 2).…”

“…Due to the deeper parenchymal localization of the hilum structures, more diverse branching and frequent variations of segmental vessels and bronchi, and more complex proximity of the intersegmental plane, anatomical segmentectomy for RS9 is more challenging. [6][7][8][9][10] RS9 is closely adjacent to the anterior and posterior basal segments (RS8 and RS10) and often shares common vascular and bronchial stems. In contrast, the right medial basal segment (RS7) is relatively independent of RS9.…”

Harnessing 3D-CT Simulation and Planning for Enhanced Precision Surgery: A Review of Applications and Advancements in Lung Cancer Treatment

“…Ohtaki et al analyzed a case series of 53 cases of complex segmentectomy compared to 65 cases of simple segmentectomy for the left upper division and reported that complex segmentectomy resulted in less blood loss volume, less major complication, and similar surgical time and duration of postoperative chest drainage and concluded that complex segmentectomy can be performed safely under the guidance of 3D-CT simulation [29]. Zhang et al assessed a case series including 42 cases of VATS anatomical complex segmentectomy for the basal segment and reported that 3D-CT simulation contributed to safe and feasible surgical procedures without conversion to open thoracotomy or lobectomy [30].…”