ABSTRACT
BACKGROUND:
Currently,
methods for identifying the intersegmental plane during anatomical
segmentectomy can be classified into 2 categories the bronchial
method and the vascular
method. One of the vascular
methods, the arterial-
ligation-alone
method, has not yet been validated or objectively evaluated in a large case series. We thus aimed to confirm that the arterial-
ligation-alone
method could effectively and accurately identify the intersegmental plane.
METHODS:
We retrospectively reviewed the
records of 104
patients who were scheduled for thoracoscopic anatomic
segmentectomy. Preoperative three-dimensional (3D) reconstruction was performed on all the affected
lungs to distinguish the targeted segmental
arteries,
veins and
bronchi. The
procedure was as follows first, based on the 3D reconstruction of the
lung, the targeted segmental
arteries were distinguished and ligated. Second, bilateral
pulmonary ventilation was performed with pure
oxygen. When the affected
lung had completely inflated, contralateral
pulmonary ventilation was performed. After waiting for some
time, the first intersegmental plane could be obtained, and the
time was recorded as T1, with an electric coagulation hook being used for marking. Thirdly, when the targeted segmental
veins and
bronchi had been ligated, the second intersegmental plane could be obtained by the
inflation-deflation
method as before, with the waiting
time being recorded as T2. The differences between the 2 intersegmental planes were evaluated by 2 experienced chief thoracic
surgeons.
RESULT:
In a total of 99 (95.2%)
patients, the intersegmental planes were successfully and accurately identified by the arterial-
ligation-alone
method. Ultimately, 85 (81.7%)
patients underwent thoracoscopic anatomic
segmentectomy. The results for evaluating the differences between the 2 planes were as follows completely consistent (94 cases, 94.9%), basically consistent (5 cases, 5.1%), and discrepant (0 cases, 0%). The mean T1 was 13.6±2.7 minutes (range, 8-25 minutes), and the mean T2 was 13.0±2.6 minutes (range, 8-23 minutes), with P=0.100 (95% CI). For 99
patients, the mean nodule size was 1.1±0.34 cm. In the 85
patients who underwent
segmentectomy, the mean margin width was 2.84±0.51 cm, the mean operative duration was 165.6±18.3 minutes, the mean operative
hemorrhage was 52.1±20.2 mL, and the mean duration of
chest tube drainage was 3.9±1.3 days.
Postoperative complications related to
operative procedures occurred in 2 cases.
CONCLUSIONS:
The arterial-
ligation-only
method can effectively, accurately and inexpensively identify the intersegmental plane, and is especially suitable for the
patients whose
veins or
bronchi are difficult to anatomize. Whether the target
bronchus is ligated has no effect on the intersegmental plane.