Thoracoscopic Anatomical Segmentectomy Research Articles

Invited Commentary

Invited Commentary

Nonintubated Thoracoscopic Anatomical Segmentectomy for Lung Tumors

Intubated general anesthesia with one-lung ventilation is considered mandatory for anatomical pulmonary resections. Nonintubated thoracoscopic segmentectomy for management of lung tumors, which is technically challenging, has not been reported previously. The goal of this study was to evaluate the feasibility and safety of thoracoscopic anatomical segmentectomy without endotracheal intubation. From August 2009 to December 2012, 21patients with lung tumors were treated using thoracoscopic anatomical segmentectomy without endotracheal intubation using a combination of thoracic epidural anesthesia, intrathoracic vagal blockade, and target-controlled sedation. There were 16 patients with primary or metastatic lung cancers and 5 patients with nonmalignant tumors. Left upper lobe apical trisegmentectomy was most commonly performed (n= 6), followed by superior segmentectomy of the right lower lobe (n= 4) and left lower lobe (n= 4). One patient required conversion to intubated single-lung ventilation because of vigorous mediastinal and diaphragmatic movement. No patient required conversion to a thoracotomy or lobectomy. Operative complications developed in 1 patient who had an air leak for more than 3 days postoperatively. The mean duration of postoperative chest tube drainage and mean hospital stay were 2.5 days and 6.0 days, respectively. Anesthetic induction and the operation required a mean 26.5 minutes and 148.0 minutes, respectively. Nonintubated thoracoscopic segmentectomy is technically feasible and safe. It can be an alternative to intubated single-lung ventilation for management of lung tumors in selected patients.

Nonintubated thoracoscopic anatomical segmentectomy for management of lung tumors

Nonintubated thoracoscopic anatomical segmentectomy for management of lung tumors

Comparative study of the anatomic segmentectomy versus lobectomy for clinical stage I A peripheral lung cancer by video assistant thoracoscopic surgery

The objective of this study was to compare the completely thoracoscopic anatomic segmentectomy with lobectomy to treat stage I(A) peripheral lung cancer <2 cm. A retrospective study was performed that 54 cases stage I(A) peripheral lung cancer patients were selected, including 26 cases of segmentectomy and 28 cases of lobectomy. We observed the operative time, blood loss, number of lymphadenectomy, post-operative chest drainage, hospital days, post-operative complications and mortality, post-operative recurrence and 3-year survival rate. There was no significant difference about complications such as post-operative atelectasis, severe pneumonia, arrhythmia and cardiovascular/cerebrovascular in two groups (P > 0.05). The local recurrence rate was not significant different in two groups (P > 0.05). Two groups of operative time, blood loss and number of dissected lymph nodes was not statistically significant (P > 0.05), However, the difference was statistically significant in average chest drainage and less decreased pulmonary function, which led to patients received segmentectomy recovered faster and hospitalized less time (P < 0.05). We also found there was no significant difference on survival rate with 1 and 3 year follow-up of two groups (log-rank Chi-square = 0.028, P > 0.05). For stage I(A) peripheral lung cancer, the thoracoscopic anatomic segmentectomy was safe and effective just as thoracoscopic lobectomy, and furthermore with faster post-operative recovery.

Thoracoscopic Lung Segmentectomy Simulated by a Tailor-Made Virtual Lung: Computed Bronchography and Angiography

We describe the benefits of simulating an anatomical lung segmentectomy using multidetector computed tomography bronchography and angiography (tailor-made virtual lung). Preoperative determination of the anatomical intersegmental plane is possible by visualizing the segmental bronchi and pulmonary vein branches. This advanced technique could be useful during thoracoscopic anatomical segmentectomy for lung cancer.

Thoracoscopic anatomic pulmonary resection.

An anatomic lobectomy is the most common surgery in general thoracic surgery, and it is called a pneumonectomy if the scope of resection is expanded and a segmentectomy if this scope is reduced. A thoracoscopic lobectomy is undoubtedly a representative surgery of the application of thoracoscopic technology in thoracic surgery, showing that the thoracoscopic technology can meet the diagnostic and treatment needs for lung disease, which leads to a greatly expanded scope of its application. This chapter will describe the thoracoscopic anatomic lobectomy, segmentectomy, and pneumonectomy. Before we introduce the surgery, we will first take a brief look at the anatomy of the lung (Figures 1,2).

Complete video-assisted thoracoscopic anatomic segmentectomy for pulmonary diseases: the early experiences

To evaluate the safety and feasibility of video-assisted thoracic surgery (VATS) anatomic segmentectomy for pulmonary diseases. Between November 2009 and July 2011, 20 patients received consecutive VATS anatomic segmentectomy by single surgical group. There were 3 male and 17 female, aging from 32 to 81 years with a mean of 53 years. The patients included 12 cases of non-small cell lung cancer (NSCLC) (5 cases of bronchioloalveolar carcinoma, 6 cases of adenocarcinoma, and 1 case of squamous cell carcinoma), 7 cases of benign diseases (3 cases of bronchiectasis, 2 cases of inflammatory pseudotumor, 1 case of tuberculosis, and 1 case of sclerosing hemangioma) and 1 case of metastasis tumor. The locations of resected segments included 1 anterior segment, 3 posterior segments, 4 apical segments, and 2 superior segments in the right side; and 5 lingular segments, 3 trisegments, and 2 superior segments in the left side. Simultaneously, 3 patients with bronchiectasis underwent segmentectomy and lobectomy, 1 of 6 patients with adenocarcinoma underwent lingulectomy and thymectomy. The pathological TNM stages of 12 NSCLC patients were 9 cases of T1aN0M0, 1 case of T1bN0M0 and 2 cases of T2aN0M0. Of these 20 patients, the median operative time was 155 minutes (range, 120 to 235 minutes), the median blood loss was 50 ml (range, 10 to 600 ml), the median drainage duration was 3 d (range, 1 to 6 d), and the median hospital stay was 6 d (range, 3 to 9 d). One patient who had undergone lingulectomy had a 600 ml intraoperative bleeding from lingular artery, and the bleeding was controlled by suturing the rupture under VATS. Bloody sputum occurred in 2 patients, prolonged air leak occurred in one patient for 5 days, and one patient developed subcutaneous emphysema that spontaneously resolved. No mortality was observed for 30 days after the surgery. VATS anatomic segmentectomy is a feasible and safe technique with acceptable operative time, less blood loss, fewer complications, and shorter hospital stay.

Complete video-assisted thoracoscopic surgery anatomic segmentectomy for clinical stage I lung carcinoma - technique and feasibility

This paper describes a prospective, observational, single-centre study of 20 consecutive patients with clinical stage I lung carcinoma undergoing anatomical sublobar resections using complete video-assisted thoracoscopic surgery (cVATS). Thirteen male and seven female patients with a median age of 68 (range 57-84) years and a median of four (range 0-9) relevant comorbid conditions presented with five right-sided and 15 left-sided tumours, with a median diameter of 2.3 (range 1.0-5.2) cm. Thirteen segmentectomies, three bisegmentectomies and four trisegmentectomies with lymphadenectomy of the N1 stations and the mediastinum were performed, with a median duration of 212 (range 91-397) min, a conversion rate to open surgery of 20% and conversion to lobectomy of 10%. In five patients, we noted 10 postoperative adverse events but no transfusions, no readmissions and zero mortality. Median drainage time was six days, with a median hospital stay of 8.5 days. According to the pTNM classification, 10, three, one, and six patients were staged as Ia, Ib, IIb and IIIa, respectively. The distance between the tumour and the parenchymal stapling line exceeded the tumour diameter in 56%, 0% and 0% of T1a, T1b and T2 tumours, respectively. To conclude, cVATS anatomical sublobar resections are technically feasible. We observed a favourable postoperative course in 20 multimorbid or aged patients. In patients fit for lobectomy, the tumour diameter should not exceed 2 cm.

Thoracoscopic Lingulectomy for Invasive Pulmonary Aspergillosis

Invasive pulmonary aspergillosis (IPA) is associated with a high mortality rate in immunocompromised patients. Surgery has a therapeutic role for selected patients when the main objective is to achieve infection control with minimal lung resection. Large or deep-seated lesions may require an anatomic resection such as segmentectomy, lobectomy, or pneumonectomy. Thoracoscopic lobectomy has been described as a treatment of localized IPA; however, thoracoscopic anatomic segmentectomy has not been reported until now. Herein, we describe a case of thoracoscopic lingulectomy for localized IPA in an immunocompromised patient: this operation minimized the delay in resuming therapy for the patient's underlying acute myeloid leukemia. Video-assisted thoracoscopic segmentectomy can be safely performed for localized IPA.