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Pezeshkian F, Leo R, McAllister MA, Singh A, Mazzola E, Hooshmand F, Herrera-Zamora J, Silvestri M, Barcelos RR, Bueno R, Figueroa PU, Jaklitsch MT, Swanson SJ. Predictors of prolonged hospital stay after segmentectomy. J Thorac Cardiovasc Surg 2025; 169:420-426. [PMID: 38688448 DOI: 10.1016/j.jtcvs.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Segmentectomy is becoming the standard of care for small, peripheral non-small cell lung cancer. To improve perioperative management in this population, this study aims to identify factors influencing hospital length of stay after segmentectomy. METHODS Patients who underwent segmentectomy for any indication between January 2018 and May 2023 were identified using a prospectively maintained institutional database. Multivariable logistic regression models were used to estimate associations between clinical features and prolonged (≥3 days) hospital stay. A nomogram was designed to understand better and possibly calculate the individual risk of prolonged hospital stays. RESULTS In total, 533 cases were included; 337 (63%) were female. Median age was 66 years (interquartile range [IQR], 63-75). The median size of resected lesions was 1.6 cm (IQR, 1.3-2.1 cm). Median hospital stay was 3 days (IQR, 2-4 days). Major adverse events occurred in 31 (5.8%) cases. The 30-day readmission rate was 5.8% (n = 31). There was no 30-day mortality; 90-day mortality was <1%. Patients older than 75 years (odds ratio [OR], 2.01, 95% confidence interval [CI], 1.15-3.57, P = .02), those with forced expiratory volume in 1 second <88% predicted (OR, 1.99; 95% CI, 1.38-2.89, P < .001), or positive smoking history (OR, 1.72; 95% CI, 1.15-2.60, P = .01) were more likely to have prolonged hospital stays after segmentectomy. A nomogram accounting for age, sex, forced expiratory volume in 1 second, body mass index, smoking history, and comorbidities was created to predict the probability of prolonged hospital stay with an area under the receiver operating characteristic curve of 0.66. CONCLUSIONS Older patients, those with reduced pulmonary function, and current and past smokers have elevated risk for prolonged hospital stays after segmentectomy. Validation of our nomogram could improve perioperative risk stratification in patients who undergo segmentectomy.
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Affiliation(s)
| | - Rachel Leo
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Miles A McAllister
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Anupama Singh
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Mass
| | - Fatemeh Hooshmand
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | | | - Mia Silvestri
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | | | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | | | | | - Scott J Swanson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
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Huang W, Gong H, Zhang H, Wang Y, Wan X, Li G, Li H, Shen H. BCNet: Bronchus Classification via Structure Guided Representation Learning. IEEE TRANSACTIONS ON MEDICAL IMAGING 2025; 44:489-498. [PMID: 39178085 DOI: 10.1109/tmi.2024.3448468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2024]
Abstract
CT-based bronchial tree analysis is a key step for the diagnosis of lung and airway diseases. However, the topology of bronchial trees varies across individuals, which presents a challenge to the automatic bronchus classification. To solve this issue, we propose the Bronchus Classification Network (BCNet), a structure-guided framework that exploits the segment-level topological information using point clouds to learn the voxel-level features. BCNet has two branches, a Point-Voxel Graph Neural Network (PV-GNN) for segment classification, and a Convolutional Neural Network (CNN) for voxel labeling. The two branches are simultaneously trained to learn topology-aware features for their shared backbone while it is feasible to run only the CNN branch for the inference. Therefore, BCNet maintains the same inference efficiency as its CNN baseline. Experimental results show that BCNet significantly exceeds the state-of-the-art methods by over 8.0% both on F1-score for classifying bronchus. Furthermore, we contribute BronAtlas: an open-access benchmark of bronchus imaging analysis with high-quality voxel-wise annotations of both anatomical and abnormal bronchial segments. The benchmark is available at https://osf.io/pskr9/?viewonly=94fa3d87274b4095ac9a4b88cc9a1341.
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Jeon OH, Kim K, Kim CG, Choi BH, Lee JH, Kim BM, Kim HK. Novel locally nebulized indocyanine green for simultaneous identification of tumor margin and intersegmental plane. Int J Surg 2024; 110:4708-4715. [PMID: 38752517 PMCID: PMC11325942 DOI: 10.1097/js9.0000000000001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/25/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Segmentectomy, recommended for early-stage lung cancer or compromised lung function, demands precise tumor detection and intersegmental plane identification. While indocyanine green (ICG) commonly aids in these aspects using near-infrared imaging, its separate administrations through different routes and times can lead to complications and patient anxiety. This study aims to develop a lung-specific delivery method by nebulizing low-dose ICG to targeted lung segments, allowing simultaneous detection of lung tumors and intersegmental planes across diverse animal models. METHODS To optimizing the dose of ICG for lung tumor and interlobar fissure detection, different doses of ICG (0.25, 0.1, and 0.05 mg/kg) were nebulized to rabbit lung tumor models. The distribution of locally nebulized ICG in targeted segments was studied to evaluate the feasibility of detecting lung tumor and intersegmental planes in canine lung pseudotumor models. RESULTS Near-infrared fluorescence imaging demonstrated clear visualization of lung tumor margin and interlobar fissure using local nebulization of 0.1 mg/kg ICG for only 4 min during surgery in the rabbit models. In the canine model, the local nebulization of 0.05 mg/kg of ICG into the target segment enabled clear visualization of pseudotumor and intersegmental planes for 30 min. CONCLUSIONS This innovative approach achieves a reduction in ICG dose and prolonged the visualization time of the intersegmental plane and effectively eliminates the need for the hurried marking of tumors and intersegmental planes. The authors anticipate that lung-specific delivery of ICG will prove valuable for image-guided limited resection of lung tumors in clinical practice.
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Affiliation(s)
- Ok Hwa Jeon
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University
- Department of Biomedical Sciences, College of Medicine, Korea University
- Image Guided Precision Cancer Surgery Institute, Seoul, Korea
| | - Kyungsu Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University
- Department of Biomedical Sciences, College of Medicine, Korea University
- Image Guided Precision Cancer Surgery Institute, Seoul, Korea
| | - Chang Geun Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University
- Department of Biomedical Sciences, College of Medicine, Korea University
- Image Guided Precision Cancer Surgery Institute, Seoul, Korea
| | - Byeong Hyeon Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University
- Image Guided Precision Cancer Surgery Institute, Seoul, Korea
| | - Jun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University
- Image Guided Precision Cancer Surgery Institute, Seoul, Korea
| | - Beop-Min Kim
- Department of Bio-Convergence, Korea University
- Image Guided Precision Cancer Surgery Institute, Seoul, Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University
- Department of Biomedical Sciences, College of Medicine, Korea University
- Image Guided Precision Cancer Surgery Institute, Seoul, Korea
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Jeon OH, Bao K, Kim K, Wang H, Yokomizo S, Park GK, Choi BH, Rho J, Kim C, Choi HS, Kim HK. Precise and safe pulmonary segmentectomy enabled by visualizing cancer margins with dual-channel near-infrared fluorescence. Int J Surg 2024; 110:2625-2635. [PMID: 38241308 PMCID: PMC11093484 DOI: 10.1097/js9.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Segmentectomy is a type of limited resection surgery indicated for patients with very early-stage lung cancer or compromised function because it can improve quality of life with minimal removal of normal tissue. For segmentectomy, an accurate detection of the tumor with simultaneous identification of the lung intersegment plane is critical. However, it is not easy to identify both during surgery. Here, the authors report dual-channel image-guided lung cancer surgery using renally clearable and physiochemically stable targeted fluorophores to visualize the tumor and intersegmental plane distinctly with different colors; cRGD-ZW800 (800 nm channel) targets tumors specifically, and ZW700 (700 nm channel) simultaneously helps discriminate segmental planes. METHODS The near-infrared (NIR) fluorophores with 700 nm and with 800 nm channels were developed and evaluated the feasibility of dual-channel fluorescence imaging of lung tumors and intersegmental lines simultaneously in mouse, rabbit, and canine animal models. Expression levels of integrin αvβ3, which is targeted by cRGD-ZW800-PEG, were retrospectively studied in the lung tissue of 61 patients who underwent lung cancer surgery. RESULTS cRGD-ZW800-PEG has clinically useful optical properties and outperforms the FDA-approved NIR fluorophore indocyanine green and serum unstable cRGD-ZW800-1 in multiple animal models of lung cancer. Combined with the blood-pooling agent ZW700-1C, cRGD-ZW800-PEG permits dual-channel NIR fluorescence imaging for intraoperative identification of lung segment lines and tumor margins with different colors simultaneously and accurately. CONCLUSION This dual-channel image-guided surgery enables complete tumor resection with adequate negative margins that can reduce the recurrence rate and increase the survival rate of lung cancer patients.
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Affiliation(s)
- Ok Hwa Jeon
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital
- Department of Biomedical Sciences
| | - Kai Bao
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kyungsu Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital
- Department of Biomedical Sciences
| | - Haoran Wang
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, People’s Republic of China
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shinya Yokomizo
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - G. Kate Park
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Byeong Hyeon Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital
| | - Jiyun Rho
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital
| | - Chungyeul Kim
- Department of Pathology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hak Soo Choi
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital
- Department of Biomedical Sciences
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Peeters M, Jansen Y, Daemen JHT, van Roozendaal LM, De Leyn P, Hulsewé KWE, Vissers YLJ, de Loos ER. The use of intravenous indocyanine green in minimally invasive segmental lung resections: a systematic review. Transl Lung Cancer Res 2024; 13:612-622. [PMID: 38601441 PMCID: PMC11002498 DOI: 10.21037/tlcr-23-807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/31/2024] [Indexed: 04/12/2024]
Abstract
Background To identify intersegmental planes (ISPs) in video/robot-assisted thoracoscopic segmentectomies, indocyanine green (ICG) is commonly used. The aim of this systematic review is to evaluate the efficacy of intravenous ICG in the identification of ISP. Methods A systematic search was performed. Studies evaluating patients who underwent a video/robot-assisted thoracoscopic segmentectomy using intravenous ICG were included. The primary outcome measure was the frequency and percentage of patients in whom the ISP was adequately visualized. Secondary outcomes encompassed the ICG dose, time to visualization, time to maximum ICG visualization, time to disappearance of ICG effect and adverse reactions to ICG. Results Eighteen studies were included for systematic review, enrolling a total of 1,090 patients. Irrespective of the injected dose, intravenous ICG identified the ISP in 94% of the cases (range, 30-100%). Overall, there was a considerable amount of heterogeneity regarding the injected dose of ICG (range, 5-25 mg or 0.05-0.5 mg/kg). The mean time before first effect of ICG was visible ranged from 10 to 40 seconds. The mean total time of ICG visibility ranged from 90 to 140 seconds after a bolus injection and was 170 seconds after continuous infusion. No adverse reactions were reported. Conclusions After administration of intravenous ICG, visualization of the ISP is successful in up to 94% of cases, even after administration of a low dose (0.05 mg/kg) of ICG. The use of intravenous ICG is safe with no reported adverse effects in the immediate peri-operative period.
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Affiliation(s)
- Maxim Peeters
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yanina Jansen
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Jean H. T. Daemen
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Lori M. van Roozendaal
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Karel W. E. Hulsewé
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yvonne L. J. Vissers
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R. de Loos
- Division of Thoracic Surgery, Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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Pischik VG, Kovalenko AI, Molkova AV, Yuryev EY, Zinchenko EI, Maslak OA. [Indocyanine green fluorescence in thoracoscopic segmentectomy: indications and benefits]. Khirurgiia (Mosk) 2024:13-23. [PMID: 38380460 DOI: 10.17116/hirurgia202402213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To determine the role of ICG fluorescence in segmentectomies. MATERIAL AND METHODS One surgical team performed 178 thoracoscopic anatomical segmentectomies in two hospitals between 2017 and 2023. Of these, 93 (52.2%) patients underwent ICG fluorescence perfusion tests. This study was retrospective and consecutive. Intraoperative and early postoperative results were analyzed. Patients were divided into 3 equal periods. Ventilation and perfusion methods were used to navigate the intersegmental planes in the first period. In the second one, only ventilation methods were used due to the absence of ICG. In the third period, the choice of navigation method was determined by «surgical complexity of segment». RESULTS In 74% of patients, surgeries were performed for primary or metastatic lung tumors. The scheduled procedure was performed in all patients. However, 2 ones required lobectomy for total resection. Uneventful postoperative period was observed in 69.7% of patients. Other ones had complications grade I-IIIA. No reoperations or mortality were recorded. CONCLUSION ICG perfusion is not inferior to ventilation methods in identification of intersegmental planes. This method is also more convenient for thoracoscopy. ICG fluorescence thoracoscopy is the only method in patients with COPD scheduled for thoracoscopic segmentectomy with two or more intersegmental planes.
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Affiliation(s)
- V G Pischik
- Saint Petersburg City Clinical Oncology Center, St. Petersburg, Russia
- Sokolov North-Western District Scientific Clinical Center, St. Petersburg, Russia
- Saint Petersburg State University, St. Petersburg, Russia
| | - A I Kovalenko
- Saint Petersburg City Clinical Oncology Center, St. Petersburg, Russia
- Sokolov North-Western District Scientific Clinical Center, St. Petersburg, Russia
| | - A V Molkova
- Saint Petersburg City Clinical Oncology Center, St. Petersburg, Russia
- Saint Petersburg State University, St. Petersburg, Russia
| | - E Yu Yuryev
- Saint Petersburg City Clinical Oncology Center, St. Petersburg, Russia
| | - E I Zinchenko
- Sokolov North-Western District Scientific Clinical Center, St. Petersburg, Russia
- Saint Petersburg State University, St. Petersburg, Russia
| | - O A Maslak
- Saint Petersburg State University, St. Petersburg, Russia
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Gelzinis TA. Indocyanine Green in Thoracic and Esophageal Surgery: What Anesthesiologists Need to Know. J Cardiothorac Vasc Anesth 2024; 38:7-11. [PMID: 37925227 DOI: 10.1053/j.jvca.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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Liu L, Aokage K, Chen C, Chen C, Chen L, Kim YH, Lee CY, Liu C, Liu CC, Nishio W, Suzuki K, Tan L, Tseng YL, Yotsukura M, Watanabe SI. Asia expert consensus on segmentectomy in non-small cell lung cancer: A modified Delphi study. JTCVS OPEN 2023; 14:483-501. [PMID: 37425437 PMCID: PMC10328970 DOI: 10.1016/j.xjon.2023.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 07/11/2023]
Abstract
Objective Segmentectomy as a parenchymal-sparing surgical approach has been recommended over lobectomy in select patients with early-stage non-small cell lung cancer. This study aimed to address 3 aspects of segmentectomy ("patient indication"; "segmentectomy approaches"; "lymph node assessment") where there is limited clinical guidance. Methods A modified Delphi approach comprising 3 anonymous surveys and 2 expert discussions was used to establish consensus on the aforementioned topics among 15 thoracic surgeons (2 Steering Committee; 2 Task Force; 11 Voting Experts) from Asia who have extensive segmentectomy experience. Statements were developed by the Steering Committee and Task Force based on their clinical experience, published literature (rounds 1-3), and comments received from Voting Experts through surveys (rounds 2-3). Voting Experts indicated their agreement with each statement on a 5-point Likert scale. Consensus was defined as ≥70% of Voting Experts selecting either "Agree"/"Strongly Agree" or "Disagree"/"Strongly Disagree." Results Consensus from the 11 Voting Experts was reached on 36 statements (11 "patient indication" statements; 19 "segmentation approaches" statements; 6 "lymph node assessment" statements). In rounds 1, 2, and 3, consensus was reached on 48%, 81%, and 100% of drafted statements, respectively. Conclusions A recent phase 3 trial reported significantly improved 5-year overall survival rates for segmentectomy compared with lobectomy, proposing thoracic surgeons to consider segmentectomy as a surgical option in suitable patients. This consensus serves as a guidance to thoracic surgeons considering segmentectomy in patients with early non-small cell lung cancer, outlining key principles that surgeons should consider in surgical decision-making.
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Affiliation(s)
- Lunxu Liu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Centre Hospital East, Chiba, Japan
| | - Chang Chen
- Division of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Yong-Hee Kim
- Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, KOO Foundation Cancer Centre, Taipei, Taiwan
| | - Wataru Nishio
- Department of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University, Tokyo, Japan
| | - Lijie Tan
- Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Centre Central Hospital, Tokyo, Japan
| | - Shun-ichi Watanabe
- Department of Thoracic Surgery, National Cancer Centre Central Hospital, Tokyo, Japan
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Bayfield NGR, Bibo L, Wang E, Edelman J. Left Upper Lobe Multi-Segmentectomy Vs Lobectomy for Early-Stage Lung Cancer: A Meta-Analysis. Heart Lung Circ 2023; 32:596-603. [PMID: 36959019 DOI: 10.1016/j.hlc.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION The left upper lobe (LUL) has unique hilar anatomy, and LUL multi-segmentectomy (apical trisegmentectomy and lingulectomy) may result in different outcomes than both single anatomical segmentectomy and left upper lobectomy in the management of early-stage primary lung cancer; however no meta-analyses have been performed. The aim of this meta-analysis is to determine if LUL multi-segmentectomy is non-inferior to left upper lobectomy for long-term survival outcomes, or superior for in-hospital outcomes. METHODS Electronic databases searches were performed on PubMed, Embase, and the Cochrane Library to identify studies comparing outcomes in LUL multi-segmentectomy vs left upper lobectomy in early-stage lung cancer (clinical stage T2 N0 or less). Long-term postoperative overall and disease-free survival were assessed via reconstruction of Kaplan-Meier survival curves. In-hospital complications and length of stay, as well as long term recurrence were analysed via random effects models. RESULTS Five relevant studies were identified, including 1,196 patients. Overall survival did not differ at 5 years (multi-segmentectomy 92.6% vs lobectomy 89.3%, P=0.188), but patients undergoing LUL multi-segmentectomy had better disease-free survival at 5 years (93.1% vs 88.4%, P=0.041). Patients undergoing LUL multi-segmentectomy had a shorter mean length of hospital stay (mean difference -0.26 days, 95% CI; -0.39 to 0.14, P<0.01, I2=0.00%). There was no difference in combined in-hospital complications (P=0.14), local recurrence (P=0.35), distant recurrence (P=0.23), or overall recurrence (P=0.39). CONCLUSION LUL multi-segmentectomy is associated with reduced hospital length of stay, but no difference in long-term overall survival compared with left upper lobectomy in the management of early-stage primary lung cancer.
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Affiliation(s)
- Nicholas G R Bayfield
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia.
| | - Liam Bibo
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
| | - Edward Wang
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
| | - James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
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Sato M. The pros and cons of uniportal VATS segmentectomy in the treatment of early-stage lung cancer: should the procedure be prioritized? J Thorac Dis 2023; 15:238-241. [PMID: 36910084 PMCID: PMC9992591 DOI: 10.21037/jtd-22-1864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Tankel J, Cools-Lartigue J. Dual Image Navigation Aiding Segmentectomy for Early NSCLC: Feasible, but Useful? Ann Surg Oncol 2023; 30:669-671. [PMID: 36380251 DOI: 10.1245/s10434-022-12679-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022]
Affiliation(s)
- James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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Usefulness of near-infrared fluorescence for identifying the segmental bronchus in minimally invasive segmentectomy. Cir Esp 2023; 101:51-54. [PMID: 35905869 DOI: 10.1016/j.cireng.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/11/2022] [Indexed: 01/17/2023]
Abstract
Minimally invasive anatomical sublobar resections have gained relevance in recent years mainly due to advances in imaging techniques, screening programs and the increase in second neoplasms. Accurate identification of the segmental or subsegmental bronchus is vital to guarantee optimal results in segmentectomies and subsegmentectomies. Given the complexity and the possibility of anatomical variations, several authors have published different methods to identify the target bronchus. However, these methods have certain limitations. This article describes a new rapid and effective technique, with a low risk of complications and without additional cost, for the identification of segmental bronchi in minimally invasive segmentectomies.
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Size Measurement and Segmentectomy Resection Margin of Early-Stage Lung Adenocarcinoma Manifesting on Virtual 3D Imagery and Pathology: A Pilot Correlation Study. J Clin Med 2022; 11:jcm11206155. [PMID: 36294475 PMCID: PMC9605571 DOI: 10.3390/jcm11206155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The objective of our study was to assess if 3D reconstructed images could be extrapolated to reflect pathologies, as evaluated by early-stage lung adenocarcinoma tumor size and simulated segmentectomy resection margin. Methods: Retrospectively selected patients (n = 18) who underwent segmentectomy at Changhua Christian Hospital between 2012 and 2018 and then had pulmonary 3D reconstruction using Ziostation2 were included in our study. Tumor size and simulated segmentectomy resection distance on a 3D model were measure and compared to pathology. Results: Both tumor size and segmentectomy resection margin showed positive correlations between 3D image measurements and pathological measurements. The resection margin showed a stronger correlation and was beneficial in pre-operative planning. Conclusions: A 3D reconstructed model aided understanding of pulmonary anatomy, prompting confidence in surgical approaches and ensured segmentectomy outcome success. Regardless of age and pulmonary function, 3D simulation can accurately mimic segmentectomy, making it a simple, effective and feasible pre-operative planning tool.
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Utilidad de la fluorescencia cercana al infrarrojo para la identificación del bronquio segmentario en segmentectomías mínimamente invasivas. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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He Z, Pan X, Li Z, Wang Q, Wang J, Wen W, Zhu Q, Wu W, Chen L. Individualized dorsal basal segment (S10) resection using intersegmental veins as the landmark. Interact Cardiovasc Thorac Surg 2021; 34:1071-1078. [PMID: 34931238 PMCID: PMC9214576 DOI: 10.1093/icvts/ivab358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/29/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Zhicheng He
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xianglong Pan
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhihua Li
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qi Wang
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Wen
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Quan Zhu
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weibing Wu
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Chen
- Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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16
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He H, Chen P, Chen X, Wang PY, Liu SY, Wang F. Analysis of anatomical variations of the lingular artery of the left upper lobe using 3D computed tomography angiography and bronchography. J Thorac Dis 2021; 13:5035-5041. [PMID: 34527341 PMCID: PMC8411136 DOI: 10.21037/jtd-21-1141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/11/2021] [Indexed: 11/06/2022]
Abstract
Background Thoracic surgeons must be familiar with the anatomy of the pulmonary artery during segmentectomy and segmentectomy. But pulmonary arteries have numerous variations and aberrant branching patterns. The purpose of the present study was to analyze the anatomical variations and frequencies of the lingular artery of the left upper lobe (LUL) using 3D computed tomography angiography and bronchography (3D-CTAB). Methods We retrospectively studied 166 patients having undergone lobectomy or segmentectomy from January to December 2020 at Fujian Medical University Cancer Hospital's Department of Thoracic Surgery. All patients underwent 3D reconstruction using 3D-CTAB before surgery. Results The lingular segment was supplied by 1 artery in 45.18% of cases, 2 arteries in 46.39% of cases, and 3 arteries in 8.43% of cases. The branching patterns of the lingular artery included 119 (71.68%) cases with interlobar origin, 35 (21.08%) cases with interlobar and mediastinal origin, and 13 (7.83%) cases with mediastinal origin. The interlobar lingular artery include superior lingular artery (A4) and inferior lingular artery (A5). The interlobar lingular artery type was A4a, A4b, A5 in 7.23% of cases; A4 and A4b+5 in 3.01% of cases; and A4b and A4a+5 in 4.82% of cases. The mediastinal lingular artery was divided into the following 5 types: 'A4', 'A4b', 'A4b+5', 'A4b+5a', and 'A4+5'. The most common type was A4 (12.05%, 20/166) in 166 patients. The interlobar lingular artery had the following 5 patterns of variation: 'A4+5', 'A4, A5', 'A4a, A4b, A5', 'A4a, A4b+5', and 'A4b, A4a+5'. The single interlobar lingular artery (A4+5) was the most common type in 38.55% of cases. In 24.10% of cases, A5 came from A8 or A8+9. Besides In 8.43% of cases, the origin of A5 was close to A8 or A8+9. Conclusions We identified the left various lingular artery branching patterns with 3D-CTAB in patients and defined the frequency of anatomic variations. 3D-CTAB is useful for finding these variations.
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Affiliation(s)
- Hao He
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Peng Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Xiaofeng Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Pei Yuan Wang
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Shuo Yan Liu
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Feng Wang
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
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Sato M, Kobayashi M, Sakamoto J, Fukai R, Takizawa H, Shinohara S, Kojima F, Sakurada A, Nakajima J. The role of virtual-assisted lung mapping 2.0 combining microcoils and dye marks in deep lung resection. J Thorac Cardiovasc Surg 2021; 164:243-251.e5. [PMID: 34654560 DOI: 10.1016/j.jtcvs.2021.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/04/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Virtual-assisted lung mapping 2.0 is a novel preoperative bronchoscopic lung mapping technique combining the multiple dye marks of conventional virtual-assisted lung mapping with intrabronchial microcoils to navigate thoracoscopic deep lung resection. This study's purpose was to evaluate the feasibility of virtual-assisted lung mapping 2.0 in resecting deeply located pulmonary nodules with adequate margins. METHODS A multicenter, prospective single-arm study was performed from 2019 to 2020 in 8 institutions. The selection criteria were barely identifiable nodules requiring sublobar lung resections, nodules requiring resection lines reaching the inner 2/3 of the pulmonary lobe on computed tomography images in wedge resection, or the nodule center located in the inner 2/3 of the pulmonary lobe in wedge resection or segmentectomy. Resection margins larger than 2 cm or the nodule diameter were considered successful resection. Bronchoscopic placement of multiple dye marks and microcoil(s) was conducted 0 to 2 days before surgery. RESULTS We analyzed 65 lesions in 64 patients. The diameter and depth of the targeted nodules and the minimum required resection depth reported as median (interquartile range) were 9 (7-13) mm, 11 (5-15) mm, and 30 (25-35) mm, respectively. Among 60 wedge resections and 5 segmentectomies, successful resection was achieved in 64 of 65 resections (98.5%; 95% confidence interval, 91.7-100). Among 75 microcoils placed, 3 showed major displacement after bronchoscopic placement. There were no severe adverse events associated with the virtual-assisted lung mapping procedure. CONCLUSIONS This study demonstrated that virtual-assisted lung mapping 2.0 can facilitate successful resections for deep pulmonary nodules, overcoming the limitations of conventional virtual-assisted lung mapping.
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Affiliation(s)
- Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan.
| | - Masashi Kobayashi
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jin Sakamoto
- Department of Thoracic Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Ryuta Fukai
- Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shinji Shinohara
- The Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, St Luke's International Hospital, Tokyo, Japan
| | - Akira Sakurada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan
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18
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Xu R, Zhao M, Zhao Y, Xuan Y, Qin Y, Jiao W. Electromagnetic navigational bronchoscopy-guided dye marking to identify the subsegmental bronchus in thoracoscopic anatomic subsegmentectomy. Thorac Cancer 2021; 12:2819-2821. [PMID: 34405556 PMCID: PMC8520799 DOI: 10.1111/1759-7714.14116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 01/02/2023] Open
Abstract
Video‐assisted thoracoscopic surgery (VATS) subsegmentectomy has been widely used to resect small‐sized lung lesions in clinical practice. Precise identification of the subsegmental bronchus is one of the essential steps in performing thoracoscopic anatomic subsegmentectomy. Here, we report a thoracoscopic right S2a segmentectomy with preoperative electromagnetic navigational bronchoscopy (ENB)‐guided injection of methylene blue to identify the subsegmental bronchus in a 51‐year‐old male. We successfully performed complicated surgery using this method. This ENB‐guided dye marking method may accurately distinguish the subsegmental bronchus to effectively guide surgery.
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Affiliation(s)
- Rongjian Xu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Min Zhao
- Center of Laboratory Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Yandong Zhao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yunpeng Xuan
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Qin
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Kim HE, Yang YH, Lee CY. Video-Assisted Thoracic Surgery Segmentectomy. J Chest Surg 2021; 54:246-252. [PMID: 34353963 PMCID: PMC8350470 DOI: 10.5090/jcs.21.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Although lobectomy remains the gold-standard surgical treatment for non-small-cell lung cancer, the frequency of thoracoscopic segmentectomy is increasing. Multiple factors must be considered in the choice of the procedure, ranging from adequate surgical planning or simulation, tumor localization, and identification of the intersegmental plane to severing the intersegmental plane to achieve an oncologically safe surgical margin with no or minimal manual palpation and different landmarks. In this article, we present an overview of methods for each procedural step of thoracoscopic segmentectomy, from preoperative planning to division of the intersegmental plane.
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Affiliation(s)
- Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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20
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Ikeda M, Tanabe M, Fujimoto A, Matsuoka T, Sumie M, Yamaura K. Predictors of failure of intersegmental line creation using bronchoscopic jet ventilation for thoracoscopic pulmonary segmentectomy. JA Clin Rep 2021; 7:53. [PMID: 34231159 PMCID: PMC8260645 DOI: 10.1186/s40981-021-00457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND During pulmonary segmentectomy, identification of the target segment is essential. We used bronchoscopic jet ventilation (BJV) to delineate the intersegmental plane by selectively sending air into the target segment. The purpose of this study was to investigate the factors associated with BJV failure. METHODS Data were retrospectively collected from 48 patients who underwent pulmonary segmentectomy with BJV between March 2014 and May 2019 at a single center. Data were compared between BJV succeeded cases and failed cases. RESULTS In 13 cases (27%), BJV were unsuccessful. The Brinkman index was significantly higher in failed cases (962 ± 965 failed vs. 395 ± 415 successful, P = 0.0067). The success rate was significantly lower when BJV was applied to the posterior basal segmental bronchus (B10) (B10: 1/5 (20%) vs others: 34/43 (79%), P = 0.015). CONCLUSION Long-term smoking and the bronchus corresponding to the posterior basal segment might make successful performance of BJV difficult.
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Affiliation(s)
- Mizuko Ikeda
- Department of Anesthesiology, Federation of National Public Service Personnel Mutual Aid Associations, Fukuoka, Japan.
- Present Address: Section of Anesthesiology, Department of Diagnostics and General Care, Fukuoka Dental College, 2-15-1, Tamura, Sawara-ku, Fukuoka, Fukuoka, 814-0193, Japan.
| | - Miwako Tanabe
- Department of Anesthesiology, Federation of National Public Service Personnel Mutual Aid Associations, Fukuoka, Japan
- Present Address: Department of Anesthesiology, St. Mary's Hospital, Fukuoka, Japan
| | - Ayumi Fujimoto
- Department of Anesthesiology, Federation of National Public Service Personnel Mutual Aid Associations, Fukuoka, Japan
| | - Tomoka Matsuoka
- Department of Anesthesiology, Federation of National Public Service Personnel Mutual Aid Associations, Fukuoka, Japan
| | - Makoto Sumie
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
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Sato M, Yang SM, Tian D, Jun N, Lee JM. Managing screening-detected subsolid nodules-the Asian perspective. Transl Lung Cancer Res 2021; 10:2323-2334. [PMID: 34164280 PMCID: PMC8182721 DOI: 10.21037/tlcr-20-243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The broad application of low-dose computed tomography (CT) screening has resulted in the detection of many small pulmonary nodules. In Asia, a large number of these detected nodules with a radiological ground glass pattern are reported as lung adenocarcinomas or premalignant lesions, especially among female non-smokers. In this review article, we discuss controversial issues and conditions involving these subsolid pulmonary nodules that we often face in Asia, including a lack or insufficiency of current guidelines; the roles of preoperative biopsy and imaging; the location of lesions; appropriate selection of localization techniques; the roles of dissection and sampling of frozen sections and lymph nodes; multifocal lesions; and the roles of non-surgical treatment modalities. For these complex issues, we have tried to present up-to-date evidence and our own opinions regarding the management of subsolid nodules. It is our hope that this article helps surgeons and physicians to manage the complex issues involving ground glass nodules (GGNs) in a balanced manner in their daily practice and provokes further discussion towards better guidelines and/or algorithms.
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Affiliation(s)
- Masaaki Sato
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Shun-Mao Yang
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan.,Department of Thoracic Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu
| | - Dong Tian
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan.,Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.,Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Nakajima Jun
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Jang-Ming Lee
- Department of Thoracic Surgery, National Taiwan University Hospital, Taipei
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22
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Yang W, Liu Z, Yang C, Liu S, Guo M, Wen W, Wang J, Liu C, Zhu Q. Combination of nitrous oxide and the modified inflation-deflation method for identifying the intersegmental plane in segmentectomy: A randomized controlled trial. Thorac Cancer 2021; 12:1398-1406. [PMID: 33817992 PMCID: PMC8088974 DOI: 10.1111/1759-7714.13919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background During thoracoscopic segmentectomy, accurately and rapidly identifying the intersegmental plane (ISP) is of great importance. This study aimed to investigate the effect and safety of a nitrous oxide (N2O)/oxygen (O2) inspired mixture on the appearance time of the ISP (TISP) via the modified inflation‐deflation method. Methods A total of 65 participants who underwent segmentectomy were randomized into three groups: 75% N2O (n = 24), 50% N2O (n = 23) or 0% N2O (n = 18). The 75% N2O group received a gas mixture of N2O/O2 (Fio2 = 0.25), the 50% N2O group received N2O/O2 (Fio2 = 0.5), and the 0% N2O group received 100% oxygen during lung expansion. The appearance time of satisfactory and ideal planes was recorded. Furthermore, arterial blood gas at breathing room air, one‐lung ventilation (OLV) before lung expansion, 5 and 15 min after lung expansion were also recorded. Results TISP was significantly shorter in the 75% N2O group (320.2 ± 65.9 s) compared with that of the 50% N2O group (552.4 ± 88.9 s, p < 0.001) and the 0% N2O group (968.3 ± 85.5 s, p < 0.001), while the 50% N2O group was shorter than that of the 0% N2O group (p < 0.001). Arterial oxygenation was significantly improved in the 0% N2O group only after lung expansion, before which there were no differences in mean PaO2 values among groups. Conclusions The use of N2O in the inspired gas mixture during lung expansion is an applicable strategy to rapidly identify the ISP via the modified inflation‐deflation method without any adverse effect on OLV related arterial oxygenation during segmentectomy.
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Affiliation(s)
- Wenjing Yang
- Department of AnesthesiologyJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Zicheng Liu
- Department of Thoracic SurgeryJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Chun Yang
- Department of AnesthesiologyJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Shijiang Liu
- Department of AnesthesiologyJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Minna Guo
- Department of AnesthesiologyJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Wei Wen
- Department of Thoracic SurgeryJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jun Wang
- Department of Thoracic SurgeryJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Cunming Liu
- Department of AnesthesiologyJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Quan Zhu
- Department of Thoracic SurgeryJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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Li C, Zheng B, Yu Q, Yang B, Liang C, Liu Y. Augmented Reality and 3-Dimensional Printing Technologies for Guiding Complex Thoracoscopic Surgery. Ann Thorac Surg 2020; 112:1624-1631. [PMID: 33275930 DOI: 10.1016/j.athoracsur.2020.10.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/24/2020] [Accepted: 10/12/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Virtual 3-dimentional models of the lungs have been used for guiding thoracoscopic procedures including segmentectomy and subsegmentectomy. However, the virtual models displayed on the screen were not tangible. A printed model with assistance of augmented reality (AR) might add value to guide surgical performance. We wanted to investigate whether the combined technology with patient-specific printed models and the AR display could offer better surgical outcomes than the on-screen models in complex thoracoscopic surgery. METHODS A total of 142 patients with early lung cancers undertaking thoracoscopic segmentectomy or subsegmentectomy. The 3-dimentional lung models were either displayed on screen (n = 87) or printed out and displayed using AR (n = 55) in the operating room. A propensity score-matching analysis was used to compare the surgical outcomes between the 2 groups. RESULTS The surgical outcomes data before and after propensity score matching showed 3-dimensional printing with AR had a shorter operating time (P = .001 and .001, respectively), less intraoperative blood loss (P = .024 and .006, respectively), and shorter length of hospital stay (P = .001 and .001, respectively) than the on-screen group. The complications and operating success rate (P = .846 and >.999, respectively) and (P = .567 and >.999, respectively) were not significantly different. Surgeons gave a higher score in the tangible group than in the on-screen group (P = .001 vs .001, respectively). CONCLUSIONS The printed 3-dimentional models enabled surgeons to see and touch interior structures of the lung. The AR provided instant guidance to the surgery in the operating room. The combination of these technologies produced positive values in guiding laparoscopic lung surgery.
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Affiliation(s)
- Chengrun Li
- Department of Thoracic Surgery, First Medical Center of PLA General Hospital, Beijing, China
| | - Bin Zheng
- Surgical Simulation Research Laboratory, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - QiLin Yu
- Department of Surgery, First Medical Center of PLA General Hospital, Beijing, China
| | - Bo Yang
- Department of Thoracic Surgery, First Medical Center of PLA General Hospital, Beijing, China
| | - Chaoyang Liang
- Department of Thoracic Surgery, First Medical Center of PLA General Hospital, Beijing, China
| | - Yang Liu
- Department of Thoracic Surgery, First Medical Center of PLA General Hospital, Beijing, China.
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Bai W, Li S. Prognosis of segmentectomy in the treatment of stage IA non-small cell lung cancer. Oncol Lett 2020; 21:74. [PMID: 33365085 PMCID: PMC7716705 DOI: 10.3892/ol.2020.12335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022] Open
Abstract
With improvements in detection technology, increasing numbers of patients with non-small cell lung cancer (NSCLC) are being diagnosed at an early stage. In order to treat the illness with minimal invasion and preserve lung function to the greatest possible extent, there has been an increasing tendency towards treating early-stage NSCLC by segmentectomy. However, questions remain regarding whether patients may benefit from this procedure considering the surgical and oncological outcomes. Whether adequate margin distance and lymph node dissection may be achieved is one of the most important issues associated with this procedure. The present study reviews the prognosis of segmentectomy in the treatment of stage IA NSCLC.
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Affiliation(s)
- Wenliang Bai
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
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Castelli M, Maurin A, Bartoli A, Dassa M, Marchi B, Finance J, Lagier JC, Million M, Parola P, Brouqui P, Raoult D, Cortaredona S, Jacquier A, Gaubert JY, Habert P. Prevalence and risk factors for lung involvement on low-dose chest CT (LDCT) in a paucisymptomatic population of 247 patients affected by COVID-19. Insights Imaging 2020; 11:117. [PMID: 33201409 PMCID: PMC7670109 DOI: 10.1186/s13244-020-00939-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/30/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Low-dose chest CT (LDCT) showed high sensitivity and ability to quantify lung involvement of COVID-19 pneumopathy. The aim of this study was to describe the prevalence and risk factors for lung involvement in 247 patients with a visual score and assess the prevalence of incidental findings. METHODS For 12 days in March 2020, 250 patients with RT-PCR positive tests and who underwent LDCT were prospectively included. Clinical and imaging findings were recorded. The extent of lung involvement was quantified using a score ranging from 0 to 40. A logistic regression model was used to explore factors associated with a score ≥ 10. RESULTS A total of 247 patients were analyzed; 138 (54%) showed lung involvement. The mean score was 4.5 ± 6.5, and the mean score for patients with lung involvement was 8.1 ± 6.8 [1-31]. The mean age was 43 ± 15 years, with 121 males (48%) and 17 asymptomatic patients (7%). Multivariate analysis showed that age > 54 years (odds ratio 4.4[2.0-9.6] p < 0.001) and diabetes (4.7[1.0-22.1] p = 0.049) were risk factors for a score ≥ 10. Multivariate analysis including symptoms showed that only age > 54 years (4.1[1.7-10.0] p = 0.002) was a risk factor for a score ≥ 10. Rhinitis (0.3[0.1-0.7] p = 0.005) and anosmia (0.3[0.1-0.9] p = 0.043) were protective against lung involvement. Incidental imaging findings were found in 19% of patients, with a need for follow-up in 0.6%. CONCLUSION The prevalence of lung involvement was 54% in a predominantly paucisymptomatic population. Age ≥ 55 years and diabetes were risk factors for significant parenchymal lung involvement. Rhinitis and anosmia were protective against LDCT abnormalities.
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Affiliation(s)
- Maxime Castelli
- Radiology Department, La Timone Hospital, Assistance Publique Des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille 05, France
| | - Arnaud Maurin
- Radiology Department, La Timone Hospital, Assistance Publique Des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille 05, France
| | - Axel Bartoli
- Radiology Department, La Timone Hospital, Assistance Publique Des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille 05, France
- UMR 7339, CNRS, CRMBM-CEMEREM (Centre de Résonance Magnétique Biologique et Médicale - Centre d'Exploration Métaboliques par Résonance Magnétique), Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, 13385, Marseille, France
| | - Michael Dassa
- Radiology Department, La Timone Hospital, Assistance Publique Des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille 05, France
| | - Baptiste Marchi
- Radiology Department, La Timone Hospital, Assistance Publique Des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille 05, France
| | | | - Jean-Christophe Lagier
- IHU-Méditerranée Infection, Marseille, France
- IRD, APHM, Aix Marseille Univ, MEPHI, Marseille, France
| | - Matthieu Million
- IHU-Méditerranée Infection, Marseille, France
- IRD, APHM, Aix Marseille Univ, MEPHI, Marseille, France
| | - Philippe Parola
- IHU-Méditerranée Infection, Marseille, France
- IRD, APHM, Aix Marseille Univ, VITROME, Marseille, SSA, France
| | - Philippe Brouqui
- IHU-Méditerranée Infection, Marseille, France
- IRD, APHM, Aix Marseille Univ, MEPHI, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France
- IRD, APHM, Aix Marseille Univ, MEPHI, Marseille, France
| | - Sebastien Cortaredona
- IHU-Méditerranée Infection, Marseille, France
- IRD, APHM, Aix Marseille Univ, VITROME, Marseille, SSA, France
| | - Alexis Jacquier
- Radiology Department, La Timone Hospital, Assistance Publique Des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille 05, France
- UMR 7339, CNRS, CRMBM-CEMEREM (Centre de Résonance Magnétique Biologique et Médicale - Centre d'Exploration Métaboliques par Résonance Magnétique), Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, 13385, Marseille, France
| | - Jean-Yves Gaubert
- Radiology Department, La Timone Hospital, Assistance Publique Des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille 05, France
- LIIE, Aix Marseille Univ, Marseille, France
- CERIMED, Aix Marseille Univ, Marseille, France
| | - Paul Habert
- Radiology Department, La Timone Hospital, Assistance Publique Des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille 05, France.
- LIIE, Aix Marseille Univ, Marseille, France.
- CERIMED, Aix Marseille Univ, Marseille, France.
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Yanagiya M, Hiyama N, Matsumoto J. Hybrid technique of virtual-assisted lung mapping and systemic indocyanine green injection for extended segmentectomy. Surg Case Rep 2020; 6:273. [PMID: 33108570 PMCID: PMC7591651 DOI: 10.1186/s40792-020-01052-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various approaches have been used to assist and facilitate segmentectomy with favorable oncological outcomes. We describe a hybrid approach comprising virtual-assisted lung mapping (VAL-MAP), which is a preoperative bronchoscopic dye-marking technique, combined with systemic indocyanine green (ICG) injection. CLINICAL PRESENTATION An asymptomatic 64-year-old man was referred to our department because of a lung nodule detected during his annual medical checkup. The chest computed-tomography image revealed a 16-mm, partly solid, ground-glass nodule in the left segment 4. Because the nodule was hardly palpable and deeply located between the left upper division segment and the left lingular segment, we performed VAL-MAP to facilitate extended left lingulectomy. Five dye markings were undertaken preoperatively. Surgery to remove the nodule was then conducted via complete three-port video-assisted thoracic surgery. The VAL-MAP markings were easily identified intraoperatively and helped locate the nodule. The intersegmental plane was identified by the ICG injection. The resection line was determined based on the intersegmental plane identified by the ICG injection and the site of the nodule suggested by the VAL-MAP markings. Following the resection line, we thoracoscopically achieved extended lingulectomy with sufficient surgical margins. The patient was discharged with no complications. The pathological diagnosis was adenocarcinoma in situ. CONCLUSION The hybrid technique of VAL-MAP and systemic ICG injection can be useful for accomplishing successful extended segmentectomy.
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Affiliation(s)
- Masahiro Yanagiya
- Department of General Thoracic Surgery, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625 Japan
| | - Noriko Hiyama
- Department of General Thoracic Surgery, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625 Japan
| | - Jun Matsumoto
- Department of General Thoracic Surgery, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625 Japan
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27
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Malouf R, Marchal C, Paget-Bailly S, Westeel V, Bernard A. Limited resections versus lobectomy for stage I non-small cell lung cancer. Hippokratia 2020. [DOI: 10.1002/14651858.cd013728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Reem Malouf
- National Perinatal Epidemiology Unit (NPEU); University of Oxford; Oxford UK
| | | | - Sophie Paget-Bailly
- Methodological and Quality of Life in Oncology Unit; University Hospital of Besançon; Besançon France
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique; Besançon France
| | - Virginie Westeel
- Methodological and Quality of Life in Oncology Unit; University Hospital of Besançon; Besançon France
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique; Besançon France
- Department of Thoracic Oncology; University Hospital of Besançon; Besançon France
| | - Alain Bernard
- Chirurgie Cardio-Vasculaire et Thoracique; CHU Dijon; Dijon Cedex France
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28
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Fan L, Yang H, Yu L, Wang Z, Ye J, Zhao Y, Cai D, Zhao H, Yao F. Multicenter, prospective, observational study of a novel technique for preoperative pulmonary nodule localization. J Thorac Cardiovasc Surg 2020; 160:532-539.e2. [PMID: 31866078 DOI: 10.1016/j.jtcvs.2019.10.148] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/30/2019] [Accepted: 10/11/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Minimally invasive surgery provides an ideal method for pathologic diagnosis and curative intent of small pulmonary nodules (SPNs); however, the main problem with thoracoscopic resection is the difficulty in locating the nodules. The goal of this study was to determine the safety and feasibility of a new localization technique tailored for SPNs. METHODS A computed tomography (CT)-guided technique, which has a tri-colored suture and claw with 4 fishhook-shaped hooks, was designed to localize SPN preoperatively. Then a multicenter, prospective study was conducted to evaluate the safety and feasibility of this device. The primary endpoints included safety (asymptomatic/symptomatic pneumothorax or parenchymal hemorrhage, and unanticipated adverse effects) and success rate (precise placement and device fracture, displacement, or dislodgement). The secondary endpoints included feasibility (duration of the localization procedure and device fracture or fault) and patient comfort (pain). RESULTS A total of 90 SPNs were localized from 80 patients. Overall, no symptomatic complications requiring medical intervention, with the exception of asymptomatic pneumothorax (n = 7 [7.8%]) and lung hemorrhages (n = 5 [5.6%]), were observed. The device was successfully placed without dislodgment or movement in 87 of 90 lesions (96.7%). The median nodule size was 0.70 cm (range, 0.30-1.0 cm). The median duration of the procedure was 15 minutes (range, 7-36 minutes). No patient complained of notable pain during or after the procedure. CONCLUSIONS This new device for SPNs is safe, and has a high success rate, feasibility and good tolerance.
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Affiliation(s)
- Liwen Fan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China; Department of Thoracic Surgery, Huadong Hospital Affiliated to FuDan University, Shanghai, China
| | - Haitang Yang
- Department of General Thoracic Surgery, Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - LingMing Yu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhexin Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianding Ye
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Deng Cai
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
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29
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Jiao P, Sun Y, Tian W, Wu Q, Tong H. Simple method for distinguishing the intersegmental plane in thoracoscopic lung segmentectomy. Thorac Cancer 2020; 11:1758-1760. [PMID: 32249507 PMCID: PMC7262899 DOI: 10.1111/1759-7714.13417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022] Open
Abstract
Here, we introduce a simple method for delineating the intersegmental border in thoracoscopic pulmonary segmentectomy which can be widely reproduced because it is less time‐consuming, fault‐tolerant, and does not require any special chemical reagents or equipment. This method provides clear and accurate demarcation lines between the inflated and deflated lung parenchyma. Key points A method with an effective and simple application which can be popularized. This modified targeted bronchus inflation method provides a clear and accurate intersegmental plane.
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Affiliation(s)
- Peng Jiao
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaoguang Sun
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenxin Tian
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingjun Wu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongfeng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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30
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Ji Y, Qiu B, Gao S. The powered vascular staple (PVS) versus conventional powered linier cutter (PLC) for the application of bronchial transection in thoracoscopic anatomic segmentectomy. J Thorac Dis 2020; 11:4647-4653. [PMID: 31903253 DOI: 10.21037/jtd.2019.10.68] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Recent studies indicated that thoracoscopic anatomical segmentectomy (TAS) is widely adopted in early non-small cell lung cancer. Considering the slender segmental bronchi and the narrow space around segmental bronchi, it is easier to treat segmental bronchi with powered vascular stapler (PVS), which was designed to have a narrower anvil and a beak like tip. However, the safety and feasibility of PVS in stapling segmental bronchi are not yet clear. Methods We retrospectively compared the perioperative features of segmental bronchial closure treated with PVS and powered linier cutter (PLC) in thoracoscopic anatomic segmentectomy performed by a single surgeon and evaluated the safety and feasibility of PVS for the segmental or subsegmental bronchus. Results Between April 2018 and April 2019, a total of 162 patients who underwent anatomic segmentectomy were analyzed (PVS n=75 and PLC n=87). No bronchopleural fistula (BPF) occurred in 162 patients. Intraoperative blood loss in PVS group (15.2±8.91 mL) was significantly lower than that in PLC group (25.29±24.06 mL) (P<0.05). The operative time of PVS group was similar to the PLC group (P>0.05). There was no significant difference between the two groups in postoperative drainage and chest tube duration (all P>0.05). In terms of postoperative complications, the incidence of hemoptysis in PVS group was similar to PLC group (P>0.05). Two cases of subcutaneous emphysema occurred in PVS group, one case of pulmonary air leakage (>3 days) and one case of subcutaneous emphysema occurred in PLC group. Besides, all the surgeons (100%) slight agree or strongly agree that PVS is easier to pass through the segmental bronchus. Conclusions PVS is a smoother and easier instrument and has the same effectiveness and security as PLC. It leads to reduced operation difficulty and potential intraoperative complications.
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Affiliation(s)
- Ying Ji
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bin Qiu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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