Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy

Wu, Weibing; Xu, Xinfeng; Wen, Wei; Xu, Jianping; Zhu, Quan; Pan, Xinliang; Xia, Yang; Chen, Liang

doi:10.21037/jtd.2016.09.43

Cited by 60 publications

(64 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surgical simulation with 3D images also helps to plan the surgical approach. Through real‐time navigation during surgery actual anatomical structures correspond one‐to‐one to the virtual anatomical structures, which reduces the difficulty and improves the accuracy of the surgical technique . In this study, we successfully completed several CSSs under 3D‐CTBA guidance and the early clinical results were satisfactory.…”

Section: Discussionmentioning

confidence: 81%

Three‐dimensional navigation‐guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules

Xia

Pan

et al. 2018

Thoracic Cancer

Self Cite

View full text Add to dashboard Cite

BackgroundExtended or combined segmentectomies are usually adapted for intersegmental pulmonary nodules. This study explored precise combined subsegmentectomy (CSS) under the guidance of three‐dimensional computed tomography bronchography and angiography (3D‐CTBA).MethodsThe definition of a pulmonary intersegmental nodule was based on a minimum distance between the nodule and the involved intersegmental veins in the preoperative 3D‐CTBA being less than the size of the nodule. Centering on the involved intersegmental vein, two adjacent subsegments belonging to the different segments were combined as a resected unit.ResultsWe retrospectively reviewed the records of 47 patients (mean age 53.6 ± 12.3, range: 26–81 years) who underwent CSS. Thirty‐nine (83.0%) nodules were involved in most intersegmental locations of the upper lobes; the remainder in the lower lobes. The mean nodule size was 0.86 ± 0.32 cm; the mean margin width was 2.20 ± 0.38 cm. Pathological stages included: Tis (8 cases), T1mi (16), IA1 (T1aN0M0, 13), and IA2 (T1bN0M0, 5). Pathological diagnoses included: invasive adenocarcinoma (18 cases), minimally invasive adenocarcinoma (16), adenocarcinoma in situ (8), atypical adenomatous hyperplasia (3), and benign (2). The average operative duration was 190.8 ± 54.9 minutes; operative hemorrhage was 42.7 ± 23.0 mL; 5.8 ± 2.8 lymph nodes dissected had not metastasized; the duration of postoperative chest tube drainage was 3.0 ± 1.8 days; and the postoperative hospital stay was 5.3 ± 2.4 days.ConclusionsUnder 3D navigation, thoracoscopic CSS is a safe technique for intersegmental nodules, sparing more pulmonary parenchyma and ensuring safe margins to achieve anatomical resection.

show abstract

Section: Discussionmentioning

confidence: 81%

Three‐dimensional navigation‐guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules

Xia

Pan

et al. 2018

Thoracic Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…Five to 12 minutes later, an irregular demarcation developed naturally between the inflated targeted segment and the deflated surrounding segments, which represented the intersegmental border to be operated on (Fig c). Combining the anatomical intersegmental vein orientation and the demarcation between the collapsed and inflated segments, a cone‐shaped dissection using either electrocautery or staples was performed safely to complete the anatomical segmentectomy (Fig d) …”

Section: Methodsmentioning

confidence: 99%

“…Combining the anatomical intersegmental vein orientation and the demarcation between the collapsed and inflated segments, a cone-shaped dissection using either electrocautery or staples was performed safely to complete the anatomical segmentectomy (Fig 1d). 4…”

Section: Methodsmentioning

confidence: 99%

Modified method for distinguishing the intersegmental border for lung segmentectomy

Wang

Wen

et al. 2017

Thoracic Cancer

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…For example, video-assisted thoracoscopic surgery (VATS) segmentectomy is more technically difficult to perform than an open thoracotomy. Furthermore, although techniques of subsegmentectomy in general are more complex, reports of VATS subsegmentectomy have been published more frequently due to an increase in the detection of smaller pulmonary nodules using developed computed tomography (CT) (2)(3)(4). In this article, we aimed to describe the techniques and roles of VATS subsegmentectomy.…”

Section: Introductionmentioning

confidence: 99%

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

et al. 2017

View full text Add to dashboard Cite

Segmentectomy has been widely performed as one of the types of limited resections that are performed for the resection of small-sized lung nodules. Video-assisted thoracoscopic surgery has also been in demand as a minimally invasive surgery. Subsegmentectomy is a much more limited resection than segmentectomy, but the technique is complex because it requires keen anatomical identification of small pulmonary structures. Therefore, there has been little reported about subsegmentectomy in medical literature. The recent development of computed tomography is remarkable, and some reports describe three-dimensional computed tomography as providing useful information because it assists surgeons in the performance of thoracoscopic anatomical subsegmentectomy. The creation of an intersubsegmental line is a key process in subsegmentectomy, therefore, some methods have been reported. We have safely and accurately performed some video-assisted thoracoscopic subsegmentectomies for small-sized lung tumors, using the three-dimensional computed tomography simulation and creating the intersubsegmental line with the inflation-deflation technique. In this article, we describe the recent techniques and roles of video-assisted thoracoscopic subsegmentectomy, and offer prospects for this procedure with our clinical data. more anatomically detailed resection that can involve the dissection of hilar lymph nodes attached to the segment containing the tumor. Moreover, the oncological outcomes of segmentectomy in a propensity-matched study were comparable to those of lobectomy for patients with earlystage non-small cell lung cancer (6). Segmentectomy has thus become widely used worldwide (1). While wedge resection has been applied to smaller lung nodules located in peripheral parenchyma, segmentectomy has been applied to small-sized lung nodules that show not only GGOs, but also solid appearances located in deep parenchyma. Recent developed CT enabled the detection of small-sized pulmonary nodules containing GGO component. For such smaller pulmonary nodules, especially located in the deep parenchyma, subsegmentectomy may be an alternative procedure; this is because it is difficult to perform a wedge resection for hilum nodules located in the deep parenchyma and segmentectomy may be an excessive resection for appropriate surgical margins.The role of subsegmentectomy is therefore considered as an intermediate procedure between wedge resection and segmentectomy. Consequently, we have concluded that the best indications for subsegmentectomy are as follows: (I) lung tumors of indeterminate nature, but considered suspicious for malignancy; (II) planned resection of a cT1aN0M0 primary lung cancer tumor less than 2 cm in diameter, with a GGO ratio of greater than 80% by highresolution CT, in patients with good pulmonary function who are able to tolerate lobectomy ( Figure 1A,B,C); (III) compromised resection in patients who are considered to be poor candidates for lobectomy due to limited cardiopulmonary reserve or other organ failure; (...

show abstract

Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy

Cited by 60 publications

References 17 publications

Three‐dimensional navigation‐guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules

Three‐dimensional navigation‐guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules

Modified method for distinguishing the intersegmental border for lung segmentectomy

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

Contact Info

Product

Resources

About