Research progress on identification of intersegmental plane and its physiological mechanism in thoracoscopic segmentectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LIU Baodong

Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;

Corresponding author：

LIU Baodong, Email: liubaodongxw@aliyun.com

Keywords：

Segmentectomy; intersegmental plane; perfusion area; ventilation area; review

DOI：

10.7507/1007-4848.202212041

Video：

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With the wide popularization of low-dose computed tomography screening for lung cancer, the proportion of early detection of lung cancer has increased significantly. Due to the favorable prognosis of ground-glass nodule-lung cancer, a prospective multicenter clinical trial in Japan has confirmed the safety and efficacy of segmentectomy. Identification of the intersegmental plane is one of the key steps in segmentectomy. Understanding its physiological mechanism can provide a theoretical basis for optimizing the identification technique, identifying intersegmental plane more accurately and quickly, improving the surgical effect and reducing complications. This article mainly introduces the identification technology of the intersegmental plane and its physiological mechanism in pulmonary segmentectomy.

Citation： LIU Baodong. Research progress on identification of intersegmental plane and its physiological mechanism in thoracoscopic segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(9): 1351-1355. doi: 10.7507/1007-4848.202212041 Copy

1.	Gao S, Zhang Z, Brunelli A, et al. The Society for Translational Medicine: Clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy. J Thorac Dis, 2017, 9(9): 3246-3254.
2.	Churchill ED, Belsey R. Segmental pneumonectomy in bronchiectasis: The lingula segment of the left upper lobe. Ann Surg, 1939, 109(4): 481-499.
3.	Overholt RH, Woods FM, Ramsay BH. Segmental pulmonary resection; details of technique and results. J Thorac Surg, 1950, 19(2): 207-225.
4.	Jensik RJ, Faber LP, Milloy FJ, et al. Segmental resection for lung cancer. A fifteen-year experience. J Thorac Cardiovasc Surg, 1973, 66(4): 563-572.
5.	Read RC, Yoder G, Schaeffer RC. Survival after conservative resection for T1 N0 M0 non-small cell lung cancer. Ann Thorac Surg, 1990, 49(3): 391-398.
6.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
7.	Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer: A multicenter study. J Thorac Cardiovasc Surg, 2006, 132(4): 769-775.
8.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
9.	Handa Y, Tsutani Y, Mimae T, et al. Surgical outcomes of complex versus simple segmentectomy for stage Ⅰ Non-small cell lung cancer. Ann Thorac Surg, 2019, 107(4): 1032-1039.
10.	Bédat B, Abdelnour-Berchtold E, Krueger T, et al. Impact of complex segmentectomies by video-assisted thoracic surgery on peri-operative outcomes. J Thorac Dis, 2019, 11(10): 4109-4118.
11.	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.
12.	Sato M, Murayama T, Nakajima J. Concepts and techniques: How to determine and identify the appropriate target segment in anatomical pulmonary segmentectomy? J Thorac Dis, 2019, 11(3): 972-986.
13.	Tsubota N. An improved method for distinguishing the intersegmental plane of the lung. Surg Today, 2000, 30(10): 963-964.
14.	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.
15.	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.
16.	Matsuoka H, Nishio W, Sakamoto T, et al. Selective segmental jet injection to distinguish the intersegmental plane using jet ventilation. Jpn J Thorac Cardiovasc Surg, 2003, 51(8): 400-401.
17.	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.
18.	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.
19.	Sekine Y, Ko E, Oishi H, et al. A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green. J Thorac Cardiovasc Surg, 2012, 143(6): 1330-1335.
20.	Oh S, Suzuki K, Miyasaka Y, et al. New technique for lung segmentectomy using indocyanine green injection. Ann Thorac Surg, 2013, 95(6): 2188-2190.
21.	Zhang Z, Liao Y, Ai B, et al. Methylene blue staining: A new technique for identifying intersegmental planes in anatomic segmentectomy. Ann Thorac Surg, 2015, 99(1): 238-242.
22.	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.
23.	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.
24.	Iwata H, Shirahashi K, Mizuno Y, et al. Surgical technique of lung segmental resection with two intersegmental planes. Interact Cardiovasc Thorac Surg, 2013, 16(4): 423-425.
25.	Zhang M, Chen L, Wu Q, et al. Functional preserving sublobectomy: A novel method for sublobectomy. Thorac Cardiovasc Surg, 2023, 71(4): 336-338.
26.	Liu Z, Yang R, Cao H. Near-infrared intraoperative imaging with indocyanine green is beneficial in video-assisted thoracoscopic segmentectomy for patients with chronic lung diseases: A retrospective single-center propensity-score matched analysis. J Cardiothorac Surg, 2020, 15(1): 303.
27.	Yotsukura M, Okubo Y, Yoshida Y, et al. Indocyanine green imaging for pulmonary segmentectomy. JTCVS Tech, 2021, 6: 151-158.
28.	Sarsam M, Glorion M, de Wolf J, et al. The role of three-dimensional reconstructions in understanding the intersegmental plane: An anatomical study of segment 6. Eur J Cardiothorac Surg, 2020, 58(4): 763-767.
29.	Kitazume M, Tane S, Shimizu N, et al. Segmental volumetric analysis with a ventilated or perfused area: Identifying the intersegmental plane. Eur J Cardiothorac Surg, 2022, 62(6): ezac537.
30.	李元博, 张毅, 支修益, 等. 3D-CTBA结合灌注区识别技术在单孔胸腔镜复杂肺段切除术中的应用. 中国肺癌杂志, 2023, 26(1): 17-21.Li YB, Zhang Y, Zhi XY, et al. Application of three-dimensional computed tomography bronchography and angiography combined with perfusion area identification technique in uniport thoracoscopic complex segmentectomy. Chin J Lung Cancer, 2023, 26(1): 17-21.

1. Gao S, Zhang Z, Brunelli A, et al. The Society for Translational Medicine: Clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy. J Thorac Dis, 2017, 9(9): 3246-3254.
2. Churchill ED, Belsey R. Segmental pneumonectomy in bronchiectasis: The lingula segment of the left upper lobe. Ann Surg, 1939, 109(4): 481-499.
3. Overholt RH, Woods FM, Ramsay BH. Segmental pulmonary resection; details of technique and results. J Thorac Surg, 1950, 19(2): 207-225.
4. Jensik RJ, Faber LP, Milloy FJ, et al. Segmental resection for lung cancer. A fifteen-year experience. J Thorac Cardiovasc Surg, 1973, 66(4): 563-572.
5. Read RC, Yoder G, Schaeffer RC. Survival after conservative resection for T1 N0 M0 non-small cell lung cancer. Ann Thorac Surg, 1990, 49(3): 391-398.
6. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
7. Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer: A multicenter study. J Thorac Cardiovasc Surg, 2006, 132(4): 769-775.
8. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
9. Handa Y, Tsutani Y, Mimae T, et al. Surgical outcomes of complex versus simple segmentectomy for stage Ⅰ Non-small cell lung cancer. Ann Thorac Surg, 2019, 107(4): 1032-1039.
10. Bédat B, Abdelnour-Berchtold E, Krueger T, et al. Impact of complex segmentectomies by video-assisted thoracic surgery on peri-operative outcomes. J Thorac Dis, 2019, 11(10): 4109-4118.
11. 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.
12. Sato M, Murayama T, Nakajima J. Concepts and techniques: How to determine and identify the appropriate target segment in anatomical pulmonary segmentectomy? J Thorac Dis, 2019, 11(3): 972-986.
13. Tsubota N. An improved method for distinguishing the intersegmental plane of the lung. Surg Today, 2000, 30(10): 963-964.
14. 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.
15. 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.
16. Matsuoka H, Nishio W, Sakamoto T, et al. Selective segmental jet injection to distinguish the intersegmental plane using jet ventilation. Jpn J Thorac Cardiovasc Surg, 2003, 51(8): 400-401.
17. 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.
18. 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.
19. Sekine Y, Ko E, Oishi H, et al. A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green. J Thorac Cardiovasc Surg, 2012, 143(6): 1330-1335.
20. Oh S, Suzuki K, Miyasaka Y, et al. New technique for lung segmentectomy using indocyanine green injection. Ann Thorac Surg, 2013, 95(6): 2188-2190.
21. Zhang Z, Liao Y, Ai B, et al. Methylene blue staining: A new technique for identifying intersegmental planes in anatomic segmentectomy. Ann Thorac Surg, 2015, 99(1): 238-242.
22. 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.
23. 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.
24. Iwata H, Shirahashi K, Mizuno Y, et al. Surgical technique of lung segmental resection with two intersegmental planes. Interact Cardiovasc Thorac Surg, 2013, 16(4): 423-425.
25. Zhang M, Chen L, Wu Q, et al. Functional preserving sublobectomy: A novel method for sublobectomy. Thorac Cardiovasc Surg, 2023, 71(4): 336-338.
26. Liu Z, Yang R, Cao H. Near-infrared intraoperative imaging with indocyanine green is beneficial in video-assisted thoracoscopic segmentectomy for patients with chronic lung diseases: A retrospective single-center propensity-score matched analysis. J Cardiothorac Surg, 2020, 15(1): 303.
27. Yotsukura M, Okubo Y, Yoshida Y, et al. Indocyanine green imaging for pulmonary segmentectomy. JTCVS Tech, 2021, 6: 151-158.
28. Sarsam M, Glorion M, de Wolf J, et al. The role of three-dimensional reconstructions in understanding the intersegmental plane: An anatomical study of segment 6. Eur J Cardiothorac Surg, 2020, 58(4): 763-767.
29. Kitazume M, Tane S, Shimizu N, et al. Segmental volumetric analysis with a ventilated or perfused area: Identifying the intersegmental plane. Eur J Cardiothorac Surg, 2022, 62(6): ezac537.
30. 李元博, 张毅, 支修益, 等. 3D-CTBA结合灌注区识别技术在单孔胸腔镜复杂肺段切除术中的应用. 中国肺癌杂志, 2023, 26(1): 17-21.Li YB, Zhang Y, Zhi XY, et al. Application of three-dimensional computed tomography bronchography and angiography combined with perfusion area identification technique in uniport thoracoscopic complex segmentectomy. Chin J Lung Cancer, 2023, 26(1): 17-21.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Research progress on identification of intersegmental plane and its physiological mechanism in thoracoscopic segmentectomy

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