Application of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIANG Zhigang ¹ , JIANG Lianyong ² , XIE Xiao ² , LI Xinjian ¹ , BI Rui ² , WANG Lei ² , WANG Mingsong ² , MEI Ju ² ,  XIAO Haibo ²

1. Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, 315000, Zhejiang, P.R.China;
2. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.China;

Corresponding author：

XIAO Haibo, Email: xiaohaibo@xinhuamed.com.cn

Keywords：

Video-assisted thoracoscopic surgery (VATS); minimally invasive; segmentectomy

DOI：

10.7507/1007-4848.201903040

Video：

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Objective To share the clinical experience of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament.Methods All the patients were in the healthy lateral position, with endoscopy holes in the 8th intercostal space of the middle axillary line and 2-3 cm operation holes in the 5th intercostal space of the front axillary line. Anatomical segmentectomy of the posterolateral basal vein, bronchus and artery was performed through the inferior pulmonary ligament upward in turn. The clinical data of this group were analyzed retrospectively.Results From December 2015 to October 2018, 32 patients underwent thoracoscopic unidirectional posterolateral basal segmentectomy, including 8 males and 24 females, aged 13-71 (52.6±13.7) years. All patients successfully completed the operation, including 9 patients of left lower pulmonary posterolateral basal segmentectomy, 23 patients of right lower pulmonary posterolateral basal segmentectomy. The operation time was 80-295 (133.4 ±40.5) minutes, intraoperative bleeding volume was 20-300 (52.6±33.8) mL, drainage time was 2-14 (4.2±2.3) days, hospitalization time was 4-15 (6.9 ±2.4) days. No death occurred during hospitalization. Postoperative complications included atelectasis in 1 patient and persistent pulmonary leakage over 3 days (4 or 6 days respectively) in 2 patients , chylothorax in 1 patient. All of them recovered smoothly after non-operative treatments. Postoperative pathology showed that 29 patients of primary adenocarcinoma or atypical adenomatoid hyperplasia, including 5 patients of adenocarcinoma in situ, 9 patients of micro-invasive adenocarcinoma, 12 patients of invasive adenocarcinoma, 3 patients of atypical adenomatoid hyperplasia. One patient was of intestinal metastatic adenocarcinoma, 1 patient of inflammatory lesion and 1 patient of bronchiectasis. 3-21(9.6±4.6) lymph nodes were resected in the patients with primary pulmonary malignant tumors. And no metastasis was found.Conclusion The operation of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament is easy. There is no need to open intersegmental tissue. It can protect lung tissue better. The operative method is worthy of clinical promotion.

Citation： LIANG Zhigang, JIANG Lianyong, XIE Xiao, LI Xinjian, BI Rui, WANG Lei, WANG Mingsong, MEI Ju, XIAO Haibo. Application of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(12): 1176-1179. doi: 10.7507/1007-4848.201903040 Copy

1.	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.
2.	Liu Y, Huang C, Liu H, et al. Sublobectomy versus lobectomy for stage ⅠA (T1a) non-small-cell lung cancer: a meta-analysis study. World J Surg Oncol, 2014, 12: 138-143.
3.	Kodama K, Higashiyama M, Okami J, et al. Oncologic outcomes of segmentectomy versus lobectomy for clinical T1a N0 M0 non-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 504-511.
4.	Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage ⅠA lung adenocarcinoma: propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
5.	Bao F, Ye P, Yang Y, et al. Segmentectomy or lobectomy for early stage lung cancer: a meta-analysis. Eur J Cardiothorac Surg, 2014, 46(1): 1-7.
6.	Ghaly G, Kamel M, Nasar A, et al. Video-assisted thoracoscopic surgery is a safe and effective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stage Ⅰnon-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 465-472.
7.	Ren M, Meng Q, Zhou W, et al. Comparison of short-term effect of thoracoscopic segmentectomy and thoracoscopic lobectomy for the solitary pulmonary nodule and early-stage lung cancer. Oncol Targets Ther, 2014, 7(3): 1343-1347.
8.	Zhang L, Ma W, Li Y, et al. Comparative study of the anatomic segmentectomy versus lobectomy for clinical stage ⅠA peripheral lung cancer by video assistant thoracoscopic surgery. J Cancer Res Ther, 2013, 9(5): S106-S109.
9.	武国栋, 张毅, 钱坤, 等. 胸腔镜肺段切除术治疗60岁以上ⅠA 期非小细胞肺癌的近期疗效. 中国微创外科杂志, 2017, 17(1): 15-18.
10.	Bédat B, Abdelnour-Berchtold E, Krueger T, et al. Clinical outcome and risk factors for complications after pulmonary segmentectomy by video-assisted thoracoscopic surgery: results of an initial experience. J Thorac Dis, 2018, 10(8): 5023-5029.
11.	Macke RA, Schuchert MJ, Odell DD, et al. Parenchymal preserving anatomic resections result in less pulmonary function loss in patients with Stage I non-small cell lung cancer. J Cardiothorac Surg, 2015, 10: 49-55.
12.	林宗武, 蒋伟, 王琳, 等. 胸腔镜基底段切除手术技巧. 中华胸部外科电子杂志, 2016, 3(2): 125-126.
13.	Sato M, Kobayashi M, Kojima F, et al. Effect of virtual-assisted lung mapping in acquisition of surgical margins in sublobar lung resection. J Thorac Cardiovasc Surg, 2018, 156(4): 1691-1701.
14.	吴卫兵, 唐立钧, 朱全, 等. 3D-CTA重建肺血管、支气管在胸腔镜复杂肺段切除中应用. 中华胸心血管外科杂志, 2015, 31(11): 649-652.
15.	刘海波, 林钢, 张诗杰, 等. 电刀切割和机械切割在全胸腔镜肺段切除段间平面分离中的应用对照研究. 中国肺癌杂志, 2017, 20(1): 41-46.

1. 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.
2. Liu Y, Huang C, Liu H, et al. Sublobectomy versus lobectomy for stage ⅠA (T1a) non-small-cell lung cancer: a meta-analysis study. World J Surg Oncol, 2014, 12: 138-143.
3. Kodama K, Higashiyama M, Okami J, et al. Oncologic outcomes of segmentectomy versus lobectomy for clinical T1a N0 M0 non-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 504-511.
4. Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage ⅠA lung adenocarcinoma: propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
5. Bao F, Ye P, Yang Y, et al. Segmentectomy or lobectomy for early stage lung cancer: a meta-analysis. Eur J Cardiothorac Surg, 2014, 46(1): 1-7.
6. Ghaly G, Kamel M, Nasar A, et al. Video-assisted thoracoscopic surgery is a safe and effective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stage Ⅰnon-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 465-472.
7. Ren M, Meng Q, Zhou W, et al. Comparison of short-term effect of thoracoscopic segmentectomy and thoracoscopic lobectomy for the solitary pulmonary nodule and early-stage lung cancer. Oncol Targets Ther, 2014, 7(3): 1343-1347.
8. Zhang L, Ma W, Li Y, et al. Comparative study of the anatomic segmentectomy versus lobectomy for clinical stage ⅠA peripheral lung cancer by video assistant thoracoscopic surgery. J Cancer Res Ther, 2013, 9(5): S106-S109.
9. 武国栋, 张毅, 钱坤, 等. 胸腔镜肺段切除术治疗60岁以上ⅠA 期非小细胞肺癌的近期疗效. 中国微创外科杂志, 2017, 17(1): 15-18.
10. Bédat B, Abdelnour-Berchtold E, Krueger T, et al. Clinical outcome and risk factors for complications after pulmonary segmentectomy by video-assisted thoracoscopic surgery: results of an initial experience. J Thorac Dis, 2018, 10(8): 5023-5029.
11. Macke RA, Schuchert MJ, Odell DD, et al. Parenchymal preserving anatomic resections result in less pulmonary function loss in patients with Stage I non-small cell lung cancer. J Cardiothorac Surg, 2015, 10: 49-55.
12. 林宗武, 蒋伟, 王琳, 等. 胸腔镜基底段切除手术技巧. 中华胸部外科电子杂志, 2016, 3(2): 125-126.
13. Sato M, Kobayashi M, Kojima F, et al. Effect of virtual-assisted lung mapping in acquisition of surgical margins in sublobar lung resection. J Thorac Cardiovasc Surg, 2018, 156(4): 1691-1701.
14. 吴卫兵, 唐立钧, 朱全, 等. 3D-CTA重建肺血管、支气管在胸腔镜复杂肺段切除中应用. 中华胸心血管外科杂志, 2015, 31(11): 649-652.
15. 刘海波, 林钢, 张诗杰, 等. 电刀切割和机械切割在全胸腔镜肺段切除段间平面分离中的应用对照研究. 中国肺癌杂志, 2017, 20(1): 41-46.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament

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