Novel techniques for video-assisted thoracoscopic surgery segmentectomy

Abstract

Small lung cancers are being increasing diagnosed because of advances in computed tomography (CT) and low-dose CT screening. Sublobar resection of peripheral, small lung nodules, such as ground-glass nodules, is a useful therapeutic option that obtains both a pathological diagnosis and radical cure. Lung segmentectomy is a better option than wedge resection for securing a sufficient surgical margin and can also be used to assess hilar nodes. Anatomical segmentectomy, however, is a technically more complicated operative procedure than standard lobectomy. We describe the issues and novel techniques of video-assisted thoracoscopic segmentectomy.

Keywords: Video-assisted thoracoscopic surgery; indocyanine green fluorescence; segmentectomy; three-dimensional reconstruction.

Figure 1

Preoperative evaluation. (A) Thin-slice computed tomography shows a part solid ground-glass nodule (GGN) in right segment 2a; (B) a virtual intersegmental plane can be established.

Figure 2

Insufficient inflation–deflation line. (A) Segment 2 is inflated, and the other segments are deflated from the lateral aspect; (B) insufficient inflation–deflation line is seen to form a fissure.

Figure 3

Indocyanine green fluorescence images and the final aspect. (A) Right segment 2 appears dark, and the residual segment appears bright. The border between these two areas is recognized as the intersegmental plane (arrows); (B) final aspect after thoracoscopic right segment 2 segmentectomy.

Figure 4

Near-infrared thoracoscopy. (A) Pinpoint; Novadaq, Kalamazoo, MI, USA. Intersegmental plane (arrows); (B) Visera Elite II; Olympus, Tokyo, Japan. Clear contrast is observed, with the background also apparent. Intersegmental plane (arrows).