How to identify the intersegmental plane?—a narrative review

Abstract

To review the different techniques to identify the intersegmental plane (ISP) during pulmonary segmentectomy by video-assisted thoracic surgery (VATS).Background: Pulmonary segmentectomy by VATS is being used increasingly. However, the difficulty in identifying the ISP may remain a technical barrier during the procedure. A 3-dimensional pre-operative planning provides a better understanding of the anatomy. Nevertheless, the surgeon needs intraoperative assistance to identify the ISP correctly. Furthermore, achieving adequate margins is of crucial importance in lung cancer to avoid local recurrence.Methods: Our narrative review focused on the different methods to identify the ISP. This narrative review was based on searches in MEDLINE, PubMed and Google Scholar database. We searched for published articles between 2000 and 2021. Keywords used for the research included "segmentectomy by VATS", "thoracoscopic segmentectomy", "ISP" and "intersegmental demarcation". We reported the pros and cons for each technique. We sort the methods of ISP demarcation in two categories: bronchial and arterial demarcation. Conclusions:We described five methods to identify the ISP, including four methods involving bronchial demarcation and one method involving arterial demarcation. All methods can permit to identify the ISP with a high rate of success. The oncological efficacy of the different techniques remains unknown.