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Review
. 2016 Nov 30:2:171.
doi: 10.21037/jovs.2016.10.04. eCollection 2016.

Thoracoscopic anatomic segmentectomies for lung cancer: technical aspects

Dominique Gossot  1 , Jon Lutz  1 , Madalina Grigoroiu  1 , Emmanuel Brian  1 , Agathe Seguin-Givelet  1   2
Affiliations
Review

Thoracoscopic anatomic segmentectomies for lung cancer: technical aspects

Dominique Gossot et al. J Vis Surg. .

Abstract

Although the interest for thoracoscopic sublobar resections (TSLR) is rising, its use for treating non-small cell lung carcinoma (NSCLC) is still controversial because publications dealing with survival and recurrence rate provide contradictory results. If applied to the resection of lung cancer, thoracoscopic segmentectomies must be performed according to oncological criteria. The aim of this technical paper is to give some technical details on thoracoscopic segmentectomies for the treatment of malignancies. Our experience is based on 235 thoracoscopic anatomical segmentectomies performed in 232 patients for a malignant lesion between January 2007 and July 2016. Indication for segmentectomy was a proven or suspected NSCLC in 184 and suspected metastasis in 51 patients. Intraoperative and postoperative data were recorded in a prospective manner. There were eight conversions into a posterolateral thoracotomy (3.4%) and seven unplanned additional pulmonary resections for an oncological reason (3%). We discuss some technical refinements that could minimize these adverse events and make thoracoscopic segmentectomy a safe and reliable procedure.

Keywords: Segmentectomy; VATS; sublobar resection; thoracoscopy.

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Conflict of interest statement

Conflicts of Interest: One of the authors (DG) is consultant for an instrument manufacturer (Delacroix Chevalier). The other authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Right S2 segmentectomy for a cT1a lung carcinoma. (A) Preoperative modelisation of the bronchial and arterial pattern; (B) preoperative modelisation demonstrating a sufficient and safe margin (pale yellow).
Figure 2
Figure 2
Planned left S3 segmentectomy for a cT1a squamous cell lung carcinoma in a patient with impaired pulmonary function. (A) CT-scan; (B) preoperative modelisation of the bronchial and arterial pattern demonstrating the nodule is actually in segment S1; (C) preoperative modelisation demonstrating an insufficient safety margin (pale yellow), requiring S1 and S3 segmentectomies. CT, computed tomography.
Figure 3
Figure 3
Usual placement of trocars for a right side segmentectomy.
Figure 4
Figure 4
Use of 3-legs retractor for exposure of station seven on the left side to ease lymph node dissection (17). Available online: http://www.asvide.com/articles/1231
Figure 5
Figure 5
Example of manual division of the bronchus during a left lingula-sparing upper lobectomy for carcinoid tumor. At frozen section, the bronchial margin was not free and was then cut back (18). Available online: http://www.asvide.com/articles/1232
Figure 6
Figure 6
Example of a full thoracoscopic approach for anatomic segmentectomy. In this case, a left S9+10 segmentectomy for a ground glass opacity (19). Available online: http://www.asvide.com/articles/1233
Figure 7
Figure 7
Patient’s position and trocar location. (A) For right segmentectomies, the surgeon stands in patient back; (B) for left segmentectomies, he/she faces him.
Figure 8
Figure 8
Example of lymph nodes clearance at the bifurcation of B3 and B1+2 during a right S3 segmentectomy for cT1aN0 NSCLC. If invaded at frozen section, the procedure must be converted into an upper lobectomy (22). NSCLC, non-small cell lung carcinoma. Available online: http://www.asvide.com/articles/1234
See this image and copyright information in PMC

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