A novel technique for identification of the segments based on pulmonary artery plane combined with oxygen diffusing discrepancy.

Abstract

Segmentectomy has been widely accepted as a powerful tool to treat small lung nodules. Despite been commonly used, identify the intersegment plane precisely in visual during the operation still being a complex issue. We described a novel method in minimal invasive thoracic surgery utilizing arterial-navigation combined with oxygen diffusing discrepancy based on the variance of oxygen diffusion in target and reserved segments. We perspectively analyzed 24 cases with small lung nodules of T1N0M0 disease to examine the efficacy of the new method. From June 2018 to September 2018, 24 patients with small primary lung cancers underwent segmentectomy at The Affiliated Hospital of Qingdao University. All the patients received minimally invasive procedures and standard anatomical segmentectomy. Ligation of the target segment artery followed by observation and the arterial-navigation line gradually appeared by color discrepancy in the visceral pleural surface. The plane was then testified by inflation-deflation method. The mean identification time of the intersegments plane was 8 minutes. The residual segments collapsed and stayed pink, meanwhile the target parts remained inflated and turned dark. It allowed a clear identification of the intersegments plane on the surface. All operations were successfully completed. There were no perioperative deaths or major complications. The coincidence rate of arterial-navigation and inflation-deflation technique was 22/24. The arterial-navigation method is safe and feasible to identify the intersegmental plane in small lung tumor resection.