Surgical technique of lung segmental resection with two intersegmental planes†

Iwata, Hiroji; Shirahashi, Koyo; Mizuno, Yoshimasa; Matsui, Masafumi; Takemura, Hirofumi

doi:10.1093/icvts/ivs560

Cited by 32 publications

(31 citation statements)

References 5 publications

(5 reference statements)

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“…With our segmentectomy, the intersegmental plane was identified using our original method (9). Briefly, in our surgical procedure, the segmental pulmonary artery and vein are divided.…”

Section: Patientsmentioning

confidence: 99%

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

et al. 2018

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Background: Division of intersegmental planes is one of the important practical issues for segmentectomy to obtain feasible outcomes without relapse for clinical stage I non-small cell lung cancer. Almost all surgeons perform this procedure using a stapler. However, division of intersegmental planes for segmentectomy can also be performed by electrocautery. In this article, we demonstrate the merits and drawbacks of division of the intersegmental plane by electrocautery for segmentectomy. Methods: Of those 125 patients who underwent segmentectomy with clinical stage I primary lung cancer, we compared cautery cases (n=50) with stapler cases (n=75). The cautery group included 29 cases (58.0%) with partial use of a staple at the end of division. Results: Operative time was significantly longer in cautery cases (281±72 min) than stapler in cases (235±86 min; P=0.003). No difference in the duration of chest tube placement was evident between cautery (3.0±3.0 days) and stapler groups (2.8±1.7 days; P=0.613). However, delayed air leakage occurred significantly more frequently in cautery cases (14.0%) than in stapler cases (4.0%; P=0.048). Five-year overall survival (OS) in clinical stage I was 94.7% in cautery cases and 80.5% in stapler cases (log-rank P=0.047). Five-year disease-free survival (DFS) was 80.0% and 71.3%, respectively (log-rank P=0.075). Conclusions: The merits of cautery division include the ability to achieve meticulous division of the intersegmental plane and good preservation of the shape of residual segments. Conversely, the drawbacks include prolonged air leakage. Pleural suture or closure of residual segments may be useful to prevent delayed air leakage.

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“…With our segmentectomy, the intersegmental plane was identified using our original method (9). Briefly, in our surgical procedure, the segmental pulmonary artery and vein are divided.…”

Section: Patientsmentioning

confidence: 99%

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

et al. 2018

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“…Similar results have been recently reported (2) and it has also been demonstrated that the thoracoscopic approach allows operating with a much lower FEV 1 than the one usually accepted for a thoracotomy (7). However, mastering thoracoscopic segmentectomy can be technically challenging and identifying the anatomy and the intersegmental plane is of concern (12,13). Once the demarcation line has been identified, choosing the adequate method of division can also be a dilemma.…”

Section: Control Chest X-raymentioning

confidence: 99%

Division of the intersegmental plane during thoracoscopic segmentectomy: is stapling an issue?

Ojanguren¹,

Gossot²,

Seguin‐Givelet³

2016

J. Thorac. Dis.

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Background: Stapling is becoming the method of choice for dividing the intersegmental plane during thoracoscopic segmentectomies. The technique however is controversial as it can impair re-expansion of preserved segments. We have analyzed the morbidity and lung re-expansion on a series of 175 thoracoscopic segmentectomies. Methods: A total of 175 patients underwent a thoracoscopic anatomic segmentectomy. Ten patients were excluded due to conversion into thoracotomy. There were 89 females (54%) and 76 males (46%). Mean age was 63 years (range, 18-83 years). Indications for segmentectomy were as follows: primary lung cancer (n=100, 61%), metastases (n=27, 16%), benign non-infectious lesions (n=20, 12%) and benign infectious lesions (n=18, 11%). The intersegmental plane was divided with an endostapler in all patients. Lung re-expansion assessment included chest roentgenograms at discharge and at one-month consultation. Results: The overall complication rate was 17%. There were 0.6% major complications and 16% minor complications. The average duration of drainage was 3 days (range, 1-13 days) and average length of stay was 5.7 days (range, 2-22 days). At discharge and at 1-month follow-up chest radiography, incomplete lung re-expansion was observed in 12 (7.4%) and 4 patients (2.8%) respectively. Patients who underwent upper lobe segmentectomy had significantly more incomplete re-expansion at discharge and at 1-month follow-up.On univariate analysis, mean drainage duration was significantly longer in patients who underwent upper segmentectomy (mean 3.7 days; range, 1-13) than those who underwent lower segmentectomy (mean 2.7 days; range, 1-5). Conclusions: Although stapling of the intersegmental plane most likely slightly impairs lung re-expansion, clinical and radiological consequences are minimal.

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“…Subsequently, we proceeded to dissect along the inflation-deflation line. Bilateral ventilation using pure oxygen might facilitate rapid deflation of the preserving segments (27). The inflation-deflation line is not easily visualized in patients with impaired lung function, such as those with chronic emphysema or chronic bronchitis with narrow airway retaining sputum.…”

Section: Discussionmentioning

confidence: 99%

Determination of the intersegmental plane using the slip-knot method

Endoh¹,

Oizumi²,

Kato³

et al. 2018

J. Thorac. Dis.

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Background: Visualization of intersegmental planes in the lung is desirable for precise anatomical lung segmentectomy. We developed the slip-knot method for creating inflation-deflation lines. This study aimed to assess relevant data for thoracoscopic segmentectomy performed using this method. Methods: In the slip-knot method, the objective segmental bronchus is looped with a monofilament thread.One end of the thread is then pulled during temporary bilateral ventilation, causing the knot to slip toward the bronchus. Thereafter, bronchial ligation is tightened to block the outflow of segmental air, ensuring that the segment remains expanded while the other reserved segments collapse on resumption of unilateral ventilation. Data from 221 patients who underwent thoracoscopic pulmonary segmentectomy between 2010 and 2016 were analyzed. Results: A total of 147 patients (67%) were indicated for the slip-knot method, and 74 cases (33%) were non-adaptive cases. Ninety six percent of 147 cases were well adapted to the slip-knot method, which allowed us to obtain good inflation-deflation line images to determine the intersegmental plane. The mean operative time was 171±51 min (range, 71-367 min). The mean duration of chest tube insertion was 1.5±1.2 days (range, 1-7 days). Three cases (2.0%) had prolonged air-leakage and one (0.7%) case had readmission for late air-leakage. Conclusions: Our method enables determination of anatomical intersegmental planes using only one monofilament thread, thus facilitating thoracoscopic pulmonary anatomical segmentectomy.

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Surgical technique of lung segmental resection with two intersegmental planes†

Cited by 32 publications

References 5 publications

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

Division of the intersegmental plane during thoracoscopic segmentectomy: is stapling an issue?

Determination of the intersegmental plane using the slip-knot method

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