Objective To evaluate the feasibility and safety of complete video-assisted thoracoscopic surgery （VATS）anatomic segmentectomy. Methods Clinical data of 26 patients with lung diseases who underwent complete VATS anatomic segmentectomy in the First Affiliated Hospital of Nanjing Medical University from November 2010 to July 2011 were retrospectively analyzed. There were 8 male and 18 female patients with their age of 13-81 （53.2±3.1） years. There were 23 patients with pulmonary nodules including 13 patients who underwent direct surgical resection and 10 patients with ground-glass opacity nodules （3 patients received preoperative localization and the other 7 patients received direct surgical resection）. All the 3 patients with non-nodule pulmonary diseases （bronchiectasis, pulmonary bulla and pulmonary cyst respectively） underwent direct surgical resection. Results All the 26 patients received complete VATS anatomic segme- ntectomy successfully. The operation time was 150-250 （193.7±7.3） min，and intraoperative blood loss was 10-200 （65.7±12.7） ml. Patients with lung cancer received 4-7 （5.1±0.3） stations of lymph node dissection and the number of lymph node dissection was 4-16 （12.3±0.5） for each patient. There was no in-hospital death or postoperative complication. Postoperative thoracic drainage time was 3-7 （3.9±0.4） days. All the patients were discharge uneventfully. Lung cancer patients were followed up for 3-6 months without recurrence or metastasis. Conclusion Complete VATS anatomic segmentectomy is a safe and feasible surgical procedure.
Objective To improve the precision of subsegmentectomy, through analyzing the proportion and classification of the intrasegmental and intersegmental trans-subsegmental artery (TSA) in the right upper lobe. Methods The imaging data of the patients who underwent pulmonary angiography in the right upper lobe from January 2021 to June 2022 at the Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The anatomy of subsegmental bronchi and arteries in the right upper lung was studied by comparing 3D CT bronchography and angiography and thin-section CT (lung window). The types of tans-subsegmental artery were further refined. Results Finally 111 patients were collected, including 36 males and 75 females with an average age of 61.83±8.91 years. There were 29 types of TSA in the right upper pulmonary artery, and 45% (13/29) of the types occurred only once. In the S1, S2, and S3 segments, the proportion of TSA was 52% (58/111), 41% (45/111), and 32% (36/111), respectively. Among them, the type with the highest proportion was A1b+A1at in S1, originating from the upper trunk artery, accounting for 67% (39/58). There were 24% (27/111), 5% (5/111), and 8% (9/111) TSA between S1 and S2, S2 and S3, and S1 and S3, respectively. There were four types of bronchi in the right upper lobe. There was no statistical difference in the proportion of the intrasegmental and intersegmental TSA (P>0.05). Conclusion The TSA in the right upper lobe is common and has various types. Segmentectomy or subsegmentectomy is a highly personalized surgical procedure.
Objective To investigate the benefits of using a stapler tractor in the treatment of segmental bronchus during lung segmentectomy through detailed video replay analysis of surgical procedures. Methods We collected data from patients who underwent segmentectomy performed by the same surgical team in the Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, from November 2020 to August 2023. After excluding data that lacked analysis parameters, the remaining patients were divided into four groups based on the methods used for dissociating segmental bronchus: a stapler tractor group (group A), a stapler with bronchial stretching group (group B), a stapler only group (group C), and a silk ligature group (group D). Then, we compared baseline data and videotaped surgical details across all groups. Surgical details included the success rate of one-time segmental bronchus dissociation and severance, the time taken for successful one-time dissociation and severance of the segmental bronchus, the incidence of bleeding during bronchus dissociation, the conversion rate to thoracotomy during surgery, and surgical outcomes such as total operative time, postoperative hospitalization days, postoperative thoracic drainage volume, and pulmonary air leakage rate. Results The study included 325 patients (203 in the group A, 62 in the group B, 29 in the group C, and 31 in the group D). There was no statistically significant difference in baseline data among the four groups. However, significant differences were found in terms of total operation time, postoperative hospitalization days, intraoperative blood loss, segmental bronchial stump length, postoperative air leakage rate, hemorrhage rate during segmental bronchial dissociation, and conversion to thoracotomy rate among the four groups (P<0.05). ConclusionUsing a stapler tractor for dissociating segmental bronchus in lung segmentectomy results in shorter operative time, less risk of intraoperative bleeding, and less surgical complications. This study provides valuable evaluation methodologies through the analysis of video replay surgical details, contributing to the improvement of lung segmentectomy quality.
Thoracoscopic pulmonary segmentectomy is one of the important treatment methods for early lung cancer. Only the premise of surgical precision can make the radical resection of lesions and maximum reservation of healthy lung tissue be simultaneously guaranteed. As a representative of the precise lung operation, the " cone-shaped lung segmentectomy” focuses on the lesion, and combines the anatomical characteristic of the patient to design individualized operation scheme. The technological core consists of three parts, three dimensional-computed tomography bronchography and angiography (3D-CTBA) surgery path planning, accurate definition of intersegmental demarcation and anatomic dissection of intersegmental borders along the demarcation. This paper aims to explore the technical process and quality control of the key techniques of thoracoscopic precise segmentectomy, so as to standardize the segmentectomy procedure under the principle of radical and minimally invasive therapy.