The Main Technical Points of Thoracoscopic Anatomical Lung Segment Resection
10.3779/j.issn.1009-3419.2016.06.16
- VernacularTitle:胸腔镜解剖性肺段切除术技术要点
- Author:
CHEN LIANG
1
;
WU WEIBING
Author Information
1. 南京医科大学第一附属医院胸外科
- Keywords:
hToracoscopy;
Pulmonary segmentectomy;
hTree-dimensional computed tomography;
Bronchogra-phy and angiography
- From:
Chinese Journal of Lung Cancer
2016;19(6):377-381
- CountryChina
- Language:Chinese
-
Abstract:
hToracoscopic segmentectomy is technically much more meticulous than lobectomy, due to the com-plicated anotomical variations of segmental bronchi and vessels. Preoperative three-dimensional computed tomography bron-chography and angiography, 3D-CTBA) could reveal the anatomical structures and variations of the segmental bronchi/vessels and locate the pulmonary nodules, which is helpful for surgery planning. Preoperative nodule localization is of vital importance for thoracoscopic segmentectomy. Techniques involved in this procedure include dissection of the targeted arteries, bronchus and intra-segmental veins, retention of the inter-segmental veins, identiifcation of the inter-segmental boarder with the inlfa-tion-delfation method and seperation of intra-segmental pulmonary tissues by electrotome and/or endoscopic staplers. hTe incision margin for malignant nodules should be at least 2 cm or the diameter of the tumor. Meanwhile, sampling of N1 and N2 station lymph nodes and intraoperative frozen section is also necessary. hTe complication rate of thoracoscopic segmentectomy is comparatively low. hTe anatomic relationship between pulmonary segments and lobes is that a lobe consists of several ir-regular cone-shaped segments with the inter-segmental veins lies between the segments. Our center has explored a method to separate pulmonary segments from the lobe on the basis of cone-shaped principle, and we named it“Cone-shaped Segmentec-tomy”. hTis technique could precisely decide and dissect the targeted bronchi and vessels, and anatomically separate the inter-segmental boarder, which ultimately achieve a completely anatomical segmentectomy.
