Unplanned Procedures During Thoracoscopic Segmentectomies

Gossot, Dominique; Lutz, Jon A.; Grigoroiu, Mădălina; Brian, Emmanuel; Seguin‐Givelet, Agathe

doi:10.1016/j.athoracsur.2017.05.081

Cited by 33 publications

(25 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On our 3D models, we have developed a virtual safety margin, which sometimes leads to extend the resection to the adjacent segment if the intersegmental parenchymal resection plan seems compromised. This does not preclude the need for an intraoperative frozen section analysis of the staple line in the event of a lesion that appears to be close (31).…”

Section: Preoperative Planning Of the Resection Margin With Confirmatmentioning

confidence: 99%

Planning and marking for thoracoscopic anatomical segmentectomies

et al. 2018

Self Cite

View full text Add to dashboard Cite

Although sublobar resection (SLR) for treating non-small cell lung carcinoma (NSCLC) is still controversial, thoracoscopic segmentectomy is rising. Performing it by closed chest surgery is complex as it means confirming the location of the lesion, identifying vascular and bronchial structures, preserving venous drainage of adjacent segments, severing the intersegmental plane and ensuring an oncological safety margin with no manual palpation and different landmarks. Accurate planning is mandatory. We discuss in this article the interest of 3D reconstruction and mapping technics to enhance safety and reliability of these procedures.

show abstract

Section: Preoperative Planning Of the Resection Margin With Confirmatmentioning

confidence: 99%

Planning and marking for thoracoscopic anatomical segmentectomies

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…resections are particularly challenging, at least for some of them (11). So, after having had to relearn thoracic surgery with the apprenticeship of video-assisted lobectomies, surgeons must again consider learning new techniques that are much more complex and challenging than thoracoscopic lobectomies.…”

mentioning

confidence: 99%

“…This will require greater accuracy, which can only be achieved with the help of some technologies. Examples include 3-dimensional modelisation for a better understanding of anatomy (11,12), mapping to locate a micronodule and delineate margins (13), intersegmental plane marking by techniques such as infrared imaging combined with systemic injection of indocyanine green (14). In an near future, virtual navigation inside the lung-as shown at the start-up corner during the conference, and augmented reality will enter our operating rooms and facilitate sublobar resections.…”

mentioning

confidence: 99%

A conference at the onset of a new era

Gossot

2018

J. Thorac. Dis.

Self Cite

View full text Add to dashboard Cite

Lung cancer surgery is evolving rapidly, faster than we could imagined a few years ago. This rapid development is related to the following observations: (I) in many countries, the tumor profile has changed dramatically, with an increasing rate of ground glass opacities and cancers detected at an early stage. This evolution is partly due to the screening programs and to the strong demand from patients and their doctors to have a CT-scan; (II) when a small suspicious pulmonary nodule is discovered, the patient legitimately asks about the most effective treatment but also the less invasive one. Surgery is now competing with other treatments, in particular stereotactic radiotherapy (SBRT) or radiofrequency whose mortality is close to zero with a morbidity comprised between 1% and 2% (1). Thus, although SBRT may have a slightly higher local recurrence rate than surgical resection and lower survival, this very low morbidity may make it the technique of choice in elderly and/ or fragile patients (2). In the near future, some small tumors may also be destroyed endoscopically using Electromagnetic Navigation Bronchoscopy. Engineers are actively working on it. Driven by these developments, the dogma of "lobectomy as standard treatment" for all non-small cell lung cancers (NSCLC), regardless of patient's age and profile, is faltering. As written by Cao, some surgeons now ask themselves the question "Could less be more?" (3). Indeed, although results of randomized trials are still pending (4,5), several recent studies seem to indicate that oncology results and survival of LRTs are equivalent to those of lobectomies for early stage NSCLC (6-8), while morbidity is much lower (9), especially when the procedure is performed via a closed chest approach (10). Finally, in 2018, more and more surgeons are choosing to treat a small tumor with a sublobar resection and the majority agree that the maximum benefit of the procedure is obtained when done by thoracoscopy. The current concern is that thoracoscopic

show abstract

“…As highlighted by Speicher et al, systematic lymph node evaluation should be mandatory, and its completion may be limited in wedge resections (9). Technically, intraoperative findings of malignancy in intersegmental lymph nodes and/or margins should warrant completion lobectomy (10). It was also not clear how many patients underwent video-assisted thoracoscopic surgery (VATS).…”

mentioning

confidence: 99%