Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

Segmentectomy has been widely performed as one of the types of limited resections that are performed for the resection of small-sized lung nodules. Video-assisted thoracoscopic surgery has also been in demand as a minimally invasive surgery. Subsegmentectomy is a much more limited resection than segmentectomy, but the technique is complex because it requires keen anatomical identification of small pulmonary structures. Therefore, there has been little reported about subsegmentectomy in medical literature. The recent development of computed tomography is remarkable, and some reports describe three-dimensional computed tomography as providing useful information because it assists surgeons in the performance of thoracoscopic anatomical subsegmentectomy. The creation of an intersubsegmental line is a key process in subsegmentectomy, therefore, some methods have been reported. We have safely and accurately performed some video-assisted thoracoscopic subsegmentectomies for small-sized lung tumors, using the three-dimensional computed tomography simulation and creating the intersubsegmental line with the inflation-deflation technique. In this article, we describe the recent techniques and roles of video-assisted thoracoscopic subsegmentectomy, and offer prospects for this procedure with our clinical data.

Planning video-assisted thoracic surgery segmentectomy using three dimensional computed tomography angiography and bronchography with a virtual safety margin

In segmentectomy using video-assisted thoracic surgery (VATS), surgeons view the operative field on a 2-dimensional video monitor. The lack of ability to palpate organs directly frequently leads to difficulties in evaluating anatomic relations. Three-dimensional computed tomography angiography and bronchography (3D-CTAB) using a virtual 3D safety margin enables thoracic surgeons to recognize the distance and positional relation between the primary tumor and intersegmental veins. It also helps with surgical planning, allowing the surgeon to secure an adequate safety margin around the primary tumor. We report two patients with double primary lung cancer who underwent segmentectomy based on preoperative simulation 3D-CTAB with a virtual 3D safety margin.