A preliminary validation of the "lung surface intersegmental constant proportion landmarks" in identifying intersegmental planes during segmentectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Yunke ¹ , ZHOU Jian ¹ , PU Qiang ¹ , MEI Jiandong ¹ , MA Lin ¹ , LIN Feng ¹ , LIU Chengwu ¹ , XU Yuyang ¹ , YANG Yi ² , REN Fuqiang ² ,  LIU Lunxu ¹

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Thoracic Surgery, The Third People's Hospital of Chengdu, Chengdu, 610014, P.R.China;

Corresponding author：

LIU Lunxu, Email: lunxu_liu@aliyun.com

Keywords：

Intersegmental plane; lung surface intersegmental constant proportion landmarks; lung surface intersegmental landmarks; visualization; lung surface intersegmental landmarks module; segmentectomy; surgery

DOI：

10.7507/1007-4848.202111054

Video：

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Objective To verify the feasibility and accuracy of the "lung surface intersegmental constant proportion landmarks", developed by our center, in identifying intersegmental planes during pulmonary segmentectomy. Methods We prospectively enrolled the patients who planned to receive thoracoscopic segmentectomy in West China Hospital of Sichuan University and The Third People's Hospital of Chengdu from September 2021 to October 2021. We took a relatively objective and feasible method, intravenous injection of indocyanine green, in identifying intersegmental planes as standard control. We intraoperatively judged the consistency between "lung surface intersegmental constant proportion landmarks" and intravenous injection of indocyanine green in identifying intersegmental planes. We discerned main landmarks of intersegmental plane by the constant proportion segment module, which was built based on the "lung surface intersegmental constant proportion landmarks", as well as distinguished the planes with discrepant fluorescence by peripheral intravenous indocyanine green injection. When the distance between the landmarks determined by the "ung surface intersegmental constant proportion landmarks" and the segmental boundaries displayed by indocyanine green fluorescence staining was ≤1 cm, the landmarks were judged to be consistent with the planes with discrepant fluorescence. As long as one of the landmarks was judged to be consistent, the method was considered to be feasible and accurate. Results A total of 21 patients who underwent thoracoscopic segmentectomy were enrolled, with 5 male and 16 female patients. The median age was 55 years, ranging from 34 to 76 years. A total of 11 patients received left-side surgery, while 10 patients received right-side surgery. In the operations of 21 pulmonary segmentectomies, at least one intersegmental landmark determined by the "lung surface intersegmental constant proportion landmarks" was consistent with the intersegmental plane determined by indocyanine green fluorescence staining in each patient. Conclusion The intersegmental landmarks determined by the "lung surface intersegmental constant proportion landmarks" are consistent with that determined by indocyanine green fluorescence staining. The method of "lung surface intersegmental constant proportion landmarks" is feasible and accurate in identifying intersegmental planes during pulmonary segmentectomy.

Citation： ZHU Yunke, ZHOU Jian, PU Qiang, MEI Jiandong, MA Lin, LIN Feng, LIU Chengwu, XU Yuyang, YANG Yi, REN Fuqiang, LIU Lunxu. A preliminary validation of the "lung surface intersegmental constant proportion landmarks" in identifying intersegmental planes during segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(12): 1476-1481. doi: 10.7507/1007-4848.202111054 Copy

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2.	Koike T, Kitahara A, Sato S, et al. Lobectomy versus segmentectomy in radiologically pure solid small-sized non-small cell lung cancer. Ann Thorac Surg, 2016, 101(4): 1354-1360.
3.	Tsubokawa N, Tsutani Y, Miyata Y, et al. Segmentectomy versus lobectomy for radiologically pure solid clinical T1A-BN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
4.	Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2020, [Epub ahead of print].
5.	Tane S, Nishio W, Nishioka Y, et al. Evaluation of the residual lung function after thoracoscopic segmentectomy compared with lobectomy. Ann Thorac Surg, 2019, 108(5): 1543-1550.
6.	Jiao P, Sun Y, Tian W, et al. Simple method for distinguishing the intersegmental plane in thoracoscopic lung segmentectomy. Thorac Cancer, 2020, 11(6): 1758-1760.
7.	Wada H, Yamamoto T, Morimoto J, et al. Near-infrared-guided pulmonary segmentectomy after endobronchial indocyanine green injection. Ann Thorac Surg, 2020, 109(2): 396-403.
8.	Tarumi S, Misaki N, Kasai Y, et al. Clinical trial of video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green. Eur J Cardiothorac Surg, 2014, 46(1): 112-115.
9.	Xu Y, Gan F, Xia C, et al. Discovery of lung surface intersegmental landmarks by three-dimensional reconstruction and morphological measurement. Transl Lung Cancer Res, 2019, 8(6): 1061-1072.
10.	Schuchert MJ, Pettiford BL, Keeley S, et al. Anatomic segmentectomy in the treatment of stageⅠnon-small cell lung cancer. Ann Thorac Surg, 2007, 84(3): 926-932; discussion 932-923.
11.	Howington JA, Blum MG, Chang AC, et al. Treatment of stageⅠandⅡnon-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e278S-e313S.
12.	Misaki N, Chang SS, Gotoh M, et al. A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg, 2009, 138(3): 613-618.
13.	Misaki N, Chang SS, Igai H, et al. New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system. J Thorac Cardiovasc Surg, 2010, 140(4): 752-756.
14.	Bédat B, Triponez F, Sadowski SM, et al. Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy. J Thorac Dis, 2018, 10(Suppl 10): S1229-S1234.
15.	Guigard S, Triponez F, Bédat B, et al. Usefulness of near-infrared angiography for identifying the intersegmental plane and vascular supply during video-assisted thoracoscopic segmentectomy. Interact Cardiovasc Thorac Surg, 2017, 25(5): 703-709.
16.	Pischik VG, Kovalenko A. The role of indocyanine green fluorescence for intersegmental plane identification during video-assisted thoracoscopic surgery segmentectomies. J Thorac Dis, 2018, 10(Suppl 31): S3704-S3711.
17.	Tsubota N. An improved method for distinguishing the intersegmental plane of the lung. Surg Today, 2000, 30(10): 963-964.
18.	Wang J, Xu X, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
19.	Kamiyoshihara M, Kakegawa S, Morishita Y. Convenient and improved method to distinguish the intersegmental plane in pulmonary segmentectomy using a butterfly needle. Ann Thorac Surg, 2007, 83(5): 1913-1914.
20.	Oizumi H, Kato H, Endoh M, et al. Slip knot bronchial ligation method for thoracoscopic lung segmentectomy. Ann Thorac Surg, 2014, 97(4): 1456-1458.
21.	Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique: Selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
22.	Oizumi H, Kanauchi N, Kato H, et al. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: A report of 52 consecutive cases. J Thorac Cardiovasc Surg, 2011, 141(3): 678-682.
23.	Chang SS, Okamoto T, Tokunaga Y, et al. Intraoperative computed tomography navigation during thoracoscopic segmentectomy for small-sized lung tumors. Semin Thorac Cardiovasc Surg, 2018, 30(1): 96-101.
24.	Sato M, Omasa M, Chen F, et al. Use of virtual assisted lung mapping (VAL-MAP), a bronchoscopic multispot dye-marking technique using virtual images, for precise navigation of thoracoscopic sublobar lung resection. J Thorac Cardiovasc Surg, 2014, 147(6): 1813-1819.

1. Abbas AE. Surgical management of lung cancer: History, evolution, and modern advances. Curr Oncol Rep, 2018, 20(12): 98.
2. Koike T, Kitahara A, Sato S, et al. Lobectomy versus segmentectomy in radiologically pure solid small-sized non-small cell lung cancer. Ann Thorac Surg, 2016, 101(4): 1354-1360.
3. Tsubokawa N, Tsutani Y, Miyata Y, et al. Segmentectomy versus lobectomy for radiologically pure solid clinical T1A-BN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
4. Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2020, [Epub ahead of print].
5. Tane S, Nishio W, Nishioka Y, et al. Evaluation of the residual lung function after thoracoscopic segmentectomy compared with lobectomy. Ann Thorac Surg, 2019, 108(5): 1543-1550.
6. Jiao P, Sun Y, Tian W, et al. Simple method for distinguishing the intersegmental plane in thoracoscopic lung segmentectomy. Thorac Cancer, 2020, 11(6): 1758-1760.
7. Wada H, Yamamoto T, Morimoto J, et al. Near-infrared-guided pulmonary segmentectomy after endobronchial indocyanine green injection. Ann Thorac Surg, 2020, 109(2): 396-403.
8. Tarumi S, Misaki N, Kasai Y, et al. Clinical trial of video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green. Eur J Cardiothorac Surg, 2014, 46(1): 112-115.
9. Xu Y, Gan F, Xia C, et al. Discovery of lung surface intersegmental landmarks by three-dimensional reconstruction and morphological measurement. Transl Lung Cancer Res, 2019, 8(6): 1061-1072.
10. Schuchert MJ, Pettiford BL, Keeley S, et al. Anatomic segmentectomy in the treatment of stageⅠnon-small cell lung cancer. Ann Thorac Surg, 2007, 84(3): 926-932; discussion 932-923.
11. Howington JA, Blum MG, Chang AC, et al. Treatment of stageⅠandⅡnon-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e278S-e313S.
12. Misaki N, Chang SS, Gotoh M, et al. A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg, 2009, 138(3): 613-618.
13. Misaki N, Chang SS, Igai H, et al. New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system. J Thorac Cardiovasc Surg, 2010, 140(4): 752-756.
14. Bédat B, Triponez F, Sadowski SM, et al. Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy. J Thorac Dis, 2018, 10(Suppl 10): S1229-S1234.
15. Guigard S, Triponez F, Bédat B, et al. Usefulness of near-infrared angiography for identifying the intersegmental plane and vascular supply during video-assisted thoracoscopic segmentectomy. Interact Cardiovasc Thorac Surg, 2017, 25(5): 703-709.
16. Pischik VG, Kovalenko A. The role of indocyanine green fluorescence for intersegmental plane identification during video-assisted thoracoscopic surgery segmentectomies. J Thorac Dis, 2018, 10(Suppl 31): S3704-S3711.
17. Tsubota N. An improved method for distinguishing the intersegmental plane of the lung. Surg Today, 2000, 30(10): 963-964.
18. Wang J, Xu X, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
19. Kamiyoshihara M, Kakegawa S, Morishita Y. Convenient and improved method to distinguish the intersegmental plane in pulmonary segmentectomy using a butterfly needle. Ann Thorac Surg, 2007, 83(5): 1913-1914.
20. Oizumi H, Kato H, Endoh M, et al. Slip knot bronchial ligation method for thoracoscopic lung segmentectomy. Ann Thorac Surg, 2014, 97(4): 1456-1458.
21. Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique: Selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
22. Oizumi H, Kanauchi N, Kato H, et al. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: A report of 52 consecutive cases. J Thorac Cardiovasc Surg, 2011, 141(3): 678-682.
23. Chang SS, Okamoto T, Tokunaga Y, et al. Intraoperative computed tomography navigation during thoracoscopic segmentectomy for small-sized lung tumors. Semin Thorac Cardiovasc Surg, 2018, 30(1): 96-101.
24. Sato M, Omasa M, Chen F, et al. Use of virtual assisted lung mapping (VAL-MAP), a bronchoscopic multispot dye-marking technique using virtual images, for precise navigation of thoracoscopic sublobar lung resection. J Thorac Cardiovasc Surg, 2014, 147(6): 1813-1819.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

A preliminary validation of the "lung surface intersegmental constant proportion landmarks" in identifying intersegmental planes during segmentectomy

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