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. 2014 Mar;3(2):170-5.
doi: 10.3978/j.issn.2225-319X.2014.02.03.

Techniques to define segmental anatomy during segmentectomy

Hiroyuki Oizumi  1 , Hirohisa Kato  1 , Makoto Endoh  1 , Takashi Inoue  1 , Hikaru Watarai  1 , Mitsuaki Sadahiro  1
Affiliations

Techniques to define segmental anatomy during segmentectomy

Hiroyuki Oizumi et al. Ann Cardiothorac Surg. 2014 Mar.

Abstract

Pulmonary segmentectomy is generally acknowledged to be more technically complex than lobectomy. Three-dimensional computed tomography (3D CT) angiography is useful for understanding the pulmonary arterial and venous branching, as well as planning the surgery to secure adequate surgical margins. Comprehension of the intersegmental and intrasegmental veins makes the parenchymal dissection easier. To visualize the segmental border, creation of an inflation-deflation line by using a method of inflating the affected segment has become the standard in small-sized lung cancer surgery. Various modifications to create the segmental demarcation line have been devised to accurately perform the segmentectomy procedure.

Keywords: Segmentectomy; slip knot; subsegmentectomy; thoracoscopy; three-dimensional computed tomography (3D CT); video-assisted thoracic surgery (VATS).

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Figures

Figure 1
Figure 1
Three-dimensional computed tomography angiography. PA, pulmonary artery; PV, pulmonary vein.
Figure 2
Figure 2
S1+2a (apical subsegment in left apical posterior segment) resection of the left upper lobe. (A) Three-dimensional computed tomography angiography with a marking of the tumor indicates two subsegmental arterial branches should be divided from the left apical posterior segmental artery. White arrow, first branch of the subsegment; Black arrow, second branch of the subsegment; (B) Operative view of the patient. The white arrow indicates the first arterial branch; (C) Operative view of the patient. The white arrow indicates the stump of the first arterial branch. The black arrow indicates the second arterial branch that was encircled in the deep parenchyma.
Figure 3
Figure 3
Schema of lung segmentectomy. The intersegmental plane is dissected preserving the intersegmental veins. Intrasegmental veins of the affected segment should be identified and divided.
Figure 4
Figure 4
Inflation-deflation line created by slip knot method.
Figure 5
Figure 5
A solid model of pulmonary arteries and veins of right upper and middle lobe molded from computed tomography data using three-dimensional (3D) printer.
See this image and copyright information in PMC

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