Modified method for distinguishing the intersegmental border for lung segmentectomy

Abstract

This paper analyzed the results of a modified and simpler technique for distinguishing the intersegmental border during lung segmentectomy surgery. From January 2013 to December 2015, 539 patients with screening‐detected lung nodules <2 cm in maximum diameter underwent anatomic segmentectomy. With the guidance of preoperative three‐dimensional computed tomography bronchography and angiography, the bronchus, artery, and intrasegmental vein of the targeted segment could be precisely dissected under unilateral differential ventilation, and then intersegmental demarcation was confirmed by the modified inflation‐deflation method. The demarcation presented by this method was highly coincident with the real intersegmental border. Dissection along the border between the collapsed and inflated segments using either electrocautery or staples was safe, with almost no air leak or bleeding. This technique is a simple and effective alternative to previously described intersegmental border marking methods.

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?

“…Under the guidance of the realtime 3D navigation and simulated navigation technique, we accurately identified and dissected targeted segmental arteries, bronchi, and intrasegmental veins. A modified inflation‐deflation method was used to identify the intersegmental plane . After the targeted segment structures were dissected, the collapsed lung was initiated to fully re‐expand with controlled airway pressure under 20 cm H 2 O, followed by single lung ventilation.…”

“…Although the feasibility of thoracoscopic segmentectomy has been widely demonstrated, there is still controversy regarding technical issues, such as the identification of the intersegmental plane. Although many studies have reported several methods for identifying the intersegmental demarcation, their essence is two types aiming to generate a demarcation: inflation‐deflation line and dyeing the plane . The former representative method is modified inflation‐deflation, and this method is precise, simple, easy to operate, and does not require additional auxiliary materials, widely used as a standard technology in clinical practice.…”

“…The former representative method is modified inflation‐deflation, and this method is precise, simple, easy to operate, and does not require additional auxiliary materials, widely used as a standard technology in clinical practice. However, it is not easy to visualize the demonstration of the intersegmental plane in pulmonary emphysema, and the inflated lung may obstruct the view of the target segment . The latter representative method is near‐infrared (NIR) fluorescence imaging with intravenous indocyanine green (ICG), which has been recently developed and several studies have reported the utility for the demonstration of the intersegmental plane .…”

Single-direction thoracoscopic basal segmentectomy

“…In such situations, a modified inflationdeflation method can be used. 31 The whole lung is re-expanded completely with controlled airway pressure under 20 cmH 2 O. Under such a circumstance, the inflation of the segment to be resected occurs after division of the target bronchus due to cross-ventilation, but deflation is delayed by the fact that the bronchus prevents rapid egress of air.…”

Simple method for distinguishing the intersegmental plane in thoracoscopic lung segmentectomy

“…This method is also less time consuming because the time it usually takes for inflation‐deflation to take place is saved. Even if the perfect demarcation does not appear at once due to inflation of the adjacent segmental parenchyma, other surgical procedures can be performed because only one lobe has inflated and would not occupy as much space as traditional or other modified inflation‐deflation methods . The method is fault‐tolerant and safe.…”