Abstract： The principles of 2010 National Comprehensive Cancer Network（NCCN） clinical practice guidelines in non-small cell lung cancer address that anatomic pulmonary resection is preferred for the majority of patients with non-small cell lung cancer and video-assisted thoracic surgery (VATS) is a reasonable and acceptable approach for patients with no anatomic or surgical contraindications. By reviewing the literatures on general treatment, pulmonary segmentectomy, pulmonary function reserve, and the anatomic issue of early stage non-small cell lung cancer surgery, the feasibility and reliability of thoracoscopic pulmonary segmentectomy are showed.
Abstract： Objective To evaluate the safety and efficacy of total thoracoscopic anatomic pulmonary segmentectomy for the treatment of early-stage peripheral lung carcinoma, pulmonary metastases and benign pulmonary diseases. Methods We retrospectively analyzed 20 patients who received total thoracoscopic anatomic pulmonary segmentectomy in Zhongshan Hospital of Fudan University from March 2008 to November 2011. There were ten male and ten female patients with a mean age of 58.0（14-86）years. Three ports were used. The pulmonary artery and vein of the segment were dealt with Hem-o-lok or stapler. The bronchi of the segment were dealt with staplers. Staplers were used in peripheral lung of intersegmental plane. Results All the twenty patients underwent total thoracoscopic anatomic segmentectomy successfully without any conversion to thoracoctomy or lobectomy. No perioperative morbidity or mortality occurred. Postoperative pathological examinations showed lung cancer in 10 patients, pulmonary metastases in 3 patients and benign pulmonary diseases in 7 patients. The mean operative time was 133.0（90-240）min. The mean blood loss was 85.0（50-200）ml. The chest tubes were maintained in position for 3.2 （2-7） d. The mean postoperative hospitalization time was 6.7 （4-11）d. Conclusion Total thoracoscopic anatomic pulmonary segmentectomy is a feasible and safe technique to be used selectively for Ⅰa stage lung cancer, pulmonary metastases and benign pulmonary diseases that are not appropriate for wedge resection.
ObjectiveTo investigate the clinical value of 3D CT combined with CT-guided Hookwire for localizing small pulmonary nodules in thoracoscopic pulmonary segmentectomy.MethodsFrom December 2017 to February 2019, 39 patients received thoracoscopic pulmonary segmentectomy in our hospital, including 14 males and 25 females with a mean age of 51.33±11.17 years. Before operation, we used Mimics Medical 20.0 to re-establish the anatomy of lung and locate the small pulmonary nodules with Hookwire guided by CT. Based on the position of Hookwire needle, 3D CT images and simulated surgical methods, thoracoscopic pulmonary segmentectomy was performed accurately.ResultsThe surgery was successfully completed in 39 patients without a transfer to open procedure. The mean operation time, mean intraoperative blood loss, mean postoperative hospital stay, mean thoracic tube drainage time were 148.97±28.56 min, 27.95±17.57 mL, 6.95±1.68 d, 4.21±1.95 d, respectively. Postoperative complications occurred in 5 patients (12.82%), including atrial fibrillation in 1, pulmonary infection in 1, chylothorax in 1, intrathoracic hemorrhage in 1 and pneumothorax in 1. All actual surgical margins were larger than 3.0 cm.ConclusionThe application of preoperative 3D CT combined with CT-guided Hookwire to localize small pulmonary nodules is helpful for accurate anatomical segmental resection of the lung, making the operation safe .
ObjectiveTo explore the feasibility and clinical value of free-of-puncture positioning in three-dimension-guided anatomical segmentectomy for ground-glass nodule (GGN) compared with percutaneous positioning.MethodsClinical data of 268 enrolled patients undergoing anatomical pulmonary segmentectomy from October 2018 to June 2019 were retrospectively collected, including 75 males and 193 females with an average age of 56.55±12.10 years. The patients were divided into two groups, including a percutaneous positioning group (n=89) and a free-of-puncture positioning group (n=179). Perioperative data of the two groups were compared.ResultsThe average CT scan times of the percutaneous positioning group was 3.01±0.98 times, and the numerical rating scale (NRS) score of puncture pain was 3.98±1.61 points. Pulmonary compression pneumothorax (≥30%) occurred in 7 (7.87%) patients and intercostal vascular hemorrhage occurred in 8 (8.99%) patients after puncture. Lung nodules were successfully found and removed in both groups. There was no statistically significant difference between the two groups in the location of nodules (P=0.466), operation time (151.83±39.23 min vs. 154.35±33.19 min, P=0.585), margin width (2.07±0.35 cm vs. 1.98±0.28 cm, P=0.750), or the number of excised subsegments (2.83±1.13 vs. 2.73±1.16, P=0.530).ConclusionAnatomical segmentectomy with three-dimensional navigation avoids the adverse consequences of puncture, which has the same clinical efficacy and meets the requirements of oncology compared with percutaneous positioning. The free-of-puncture positioning method can be used for GGN located in the central region of pulmonary segment/subsegment or adjacent to intersegment veins instead of percutaneous positioning.
ObjectiveTo investigate the clinical effect of 3D computed tomography bronchial bronchography and angiography (3D-CTBA) and guidance of thoracoscopic anatomic pulmonary segmentectomy by Mimics software system. MethodsA retrospective analysis was performed on patients who underwent thoracoscopic segmentectomy in the Department of Thoracic Surgery of Affiliated People's Hospital of Jiangsu University from June 2020 to December 2022. The patients who underwent preoperative 3D-CTBA using Materiaise's interactive medical image control system (Mimics) were selected as an observation group, and the patients who did not receive 3D-CTBA were selected as a control group. The relevant clinical indicators were compared between the two groups. ResultsA total of 59 patients were included, including 29 males and 30 females, aged 25-79 years. There were 37 patients in the observation group, and 22 patients in the control group. The operation time (163.0±48.7 min vs. 188.8±43.0 min, P=0.044), intraoperative blood loss [10.0 (10.0, 20.0) mL vs. 20.0 (20.0, 35.0) mL, P<0.001], and preoperative puncture localization rate (5.4% vs. 31.8%, P=0.019) in the observation group were better than those in the control group. There was no statistically significant difference in the thoracic tube placement time, thoracic fluid drainage volume, number of intraoperative closure nail bin, postoperative hospital stay, or postoperative air leakage incidence (P>0.05) between the two groups. ConclusionFor patients who need to undergo anatomical pulmonary segmentectomy, using Mimics software to produce 3D-CTBA before surgery can help accurately identify pulmonary arteriovenous anatomy, reduce surgical time and intraoperative blood loss, help to determine the location of nodules and reduce invasive localization before surgery, and alleviate patients' pain, which is worthy of clinical promotion.