[Identification of intersegmental border in radical segmentectomy]

Abstract

Current evidence indicates that radical sublobar resection (segmentectomy and wedge resection) should be considered as an alternative for cT1N0 lung cancer of 2 cm or less, even in low-risk patients. Segmentectomy is an anatomic parenchyma-sparing resection that is recently being performed for small-sized lung carcinoma and constitutes a useful procedure in a thoracic surgeon's armamentarium. The technique is presented that improves the identification of the intersegmental border. Under bronchofiberscopy, jet ventilation is selectively applied to the burdened bronchus to develop an anatomic plane between the inflated segment to be resected and the deflated area to be preserved. The patients with a clinical T1NOMO peripheral cancer 2 cm or smaller underwent video-assisted segmental resection called hybrid video-assisted thoracic surgery (VATS) segmentectomy in which electrocautery with no stapler was used to divide the intersegmental plane detected by selective jet ventilation. Selective segmental inflation provides an obvious intersegmental plane quickly and easily, allowing a real margin distance in the ventilated segment. Despite the minimally invasive approach, since only the segment to be resected and not the entire lobe is expanded, an appropriate surgical view is possible.