Technique for tailoring complex demarcation in lung segmentectomy

Abstract

Segmentectomy is a widely adopted surgical procedure, however, experiences of tailoring the intersegmental border have rarely been reported. This paper investigates the strategy and results of tailoring complex demarcation during lung segmentectomy surgery. Because intersegmental demarcation can be divided into plane or curved types according to the location and stereo shape of a segment, a one‐size‐fits‐all method for tailoring the intersegmental demarcation is obviously unreasonable. For tailoring a complex segmentectomy with two or more curved borders, tips including good exposure of the intersegmental demarcation, sharp‐blunt combined dissection skill, “work‐plane” extension, and “gate” opening techniques all contribute to an accurate segmentectomy. This technique, based on anatomical characteristics, can provide a cutting surface with a greater physiological shape and less curling of the edge, and should be recommended as a general standard method for tailoring complex demarcation.

Technical aspects and early results of uniportal video-assisted thoracoscopic complex segmentectomy: a 30 case-series study

“…In our study, 1 patient experienced a prolonged air leak and stayed in the hospital for 20 days after the operation. Air leakage is one of the major complications after segmentectomy [ 18 ]. The main causes of air leakage are (1) visceral pleural injury when dissecting the segmental vessels, bronchus and lymph nodes; (2) pulmonary parenchymal injury when energy devices are used for the management of the intersegmental plane; (3) air leakage at the nail holes of the stapler in patients with emphysema; and (4) bronchus injury.…”

A novel form of precise segmentectomy—Triumphal arch‐like anatomical segmentectomy

“…To the best of our knowledge, this is the first report to introduce triumphal arch‐like anatomical sublobectomy. For a complex curved border, with typically lateral basal segments or some combined subsegments, tailoring with the stapler alone will cause severe crush and curling of the cutting edge and subsequent atelectasis or venous pleonemia of the retained segments 4 . This technique is based on the combined dimensional reduction method.…”

Electrocautery vs. Stapler in Comparing Safety for Segmentectomy of Lung Cancer: A Meta-Analysis

“…A retrospective study performed by Tao et al ( 24 ) in 2019 proved that the loss of pulmonary function caused by using staplers was acceptable. Given the unclear result, most surgeons are inclined to choose the instruments by individual habits ( 25 ). Electrocautery has other merits such as preserving more pulmonary functions and a lower cost ( 14 ).…”