Thoracoscopic combined subsegmentectomy for 76 patients: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAN Bicheng ,  LIU Jian , CHEN Jian , LIU Yongzhi , LI Genshui , GUO Kunliang , WANG Xiao , XIONG Yanzheng , GU Mingbo

Department of Cardiothoracic Surgery, Anqing Municipal Hospital, Anqing Medical Center of Anhui Medical University, Anqing, 246003, Anhui, P. R. China;

Corresponding author：

LIU Jian, Email: liujianaqslyy@126.com

Keywords：

Thoracoscopy; minimally invasive; combined subsegmentectomy

DOI：

10.7507/1007-4848.202207076

Video：

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Objective To summarize the clinical experience of thoracoscopic combined subsegmentectomy (CSS). Methods The clinical data of 76 patients who underwent thoracoscopic CSS in Anqing Municipal Hospital from May 2018 to July 2022 were retrospectively analyzed, including 22 males and 54 females, aged 27.0-76.0 (54.3±10.5) years. All patients underwent preoperative three-dimensional computed tomography bronchography and angiography using dual source CT. The modified inflation-deflation technique or indocyanine green was used to identify the intersubsegmental border. Results A total of 86 pulmonary nodules were resected in 76 patients. One patient of left upper lobe S¹⁺²c+S⁴a, 1 patient of right upper lobe S²b+S³a and 1 patient of right upper lobe S¹b+S³b were further performed lobectomy due to insufficient margin. One patient of left upper lobe S¹⁺²+S³a was further performed left upper division segmentectomy due to residual atelectasis. One patient of left upper lobe S¹⁺²c+S³a was further performed left upper division segmentectomy due to B³b+c injury, and the rest completed planned surgeries successfully. The operative time was 90.0-350.0 (174.9±53.2) min. The operative hemorrhage volume was 50.0 (20.0, 50.0) mL. The postoperative hospital stay time was 6.0 (5.0, 7.0) d. Postoperative complications included pulmonary infection in 9 patients, hemoptysis in 3 patients, persistent pulmonary leakage>3 d in 4 patients, pneumothorax in 1 patient, pleural effusion in 1 patient, and myocardial infarction in 1 patient. All of the patients were cured and discharged without perioperative death. Conclusion Thoracoscopic CSS is relatively complex. Preoperative planning under three-dimensional reconstruction and intraoperative fine operation are helpful for safe completion.

Citation： ZHAN Bicheng, LIU Jian, CHEN Jian, LIU Yongzhi, LI Genshui, GUO Kunliang, WANG Xiao, XIONG Yanzheng, GU Mingbo. Thoracoscopic combined subsegmentectomy for 76 patients: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 47-51. doi: 10.7507/1007-4848.202207076 Copy

1.	黄晶晶, 陈志鹏, 卞承禹, 等. 以肺亚段为解剖单元的肺结节手术策略及临床结果的单中心回顾性分析. 中国胸心血管外科临床杂志, 2022, 29(1): 36-43.
2.	Yoshimoto K, Nomori H, Mori T, et al. Combined subsegmentectomy: Postoperative pulmonary function compared to multiple segmental resection. J Cardiothorac Surg, 2011, 6: 17.
3.	Nakamoto K, Omori K, Nezu K, et al. Superselective segmentectomy for deep and small pulmonary nodules under the guidance of three-dimensional reconstructed computed tomographic angiography. Ann Thorac Surg, 2010, 89(3): 877-883.
4.	梁志刚, 蒋连勇, 谢晓, 等. 经下肺韧带方向胸腔镜单向式肺后外基底段切除的应用. 中国胸心血管外科临床杂志, 2019, 26(12): 1176-1179.
5.	刘成武, 蒲强, 梅建东, 等. 单向式胸腔镜基底段切除术352例的单中心回顾性研究. 中国胸心血管外科临床杂志, 2022, 29(10): 1284-1289.
6.	陈昶, 朱余明, 姜格宁, 等. 肺段切除术和肺叶切除术治疗直径≤2 cm 且术中冰冻证实微乳头和实性亚型阴性肺腺癌的多中心随机对照研究. 中国胸心血管外科临床杂志, 2021, 28(11): 1292-1298.
7.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
8.	Perez Holguin RA, Olecki EJ, Wong WG, et al. Outcomes after sublobar resection versus lobectomy in non-small cell carcinoma in situ. J Thorac Cardiovasc Surg, 2022, S0022-5223(22): 00627-4.
9.	Wu W, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
10.	詹必成, 刘建, 陈剑, 等. 三维重建引导下胸腔镜扩大肺亚段切除术治疗肺段边缘结节. 中国微创外科杂志, 2021, 21(10): 904-907.
11.	Hu W, Zhang K, Han X, et al. Three-dimensional computed tomography angiography and bronchography combined with three-dimensional printing for thoracoscopic pulmonary segmentectomy in stage ⅠA non-small cell lung cancer. J Thorac Dis, 2021, 13(2): 1187-1195.
12.	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.
13.	陈亮, 王俊, 吴卫兵, 等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 21-28.
14.	Hagiwara M, Shimada Y, Kato Y, et al. High-quality 3-dimensional image simulation for pulmonary lobectomy and segmentectomy: Results of preoperative assessment of pulmonary vessels and short-term surgical outcomes in consecutive patients undergoing video-assisted thoracic surgery. Eur J Cardiothorac Surg, 2014, 46(6): e120-e126.
15.	陈剑, 刘建, 詹必成, 等. 肺动脉丝线结扎法在胸腔镜肺叶切除术中的应用. 中国胸心血管外科临床杂志, 2016, 23(5): 459-462.
16.	Oizumi H, Kato H, Endoh M, et al. Management of bronchial stumps in anatomic lung segmentectomy. Ann Thorac Surg, 2016, 101(6): 2120-2124.
17.	Yao F, Wu W, Zhu Q, et al. Thoracoscopic pulmonary segmentectomy with collateral ventilation method. Ann Thorac Surg, 2021, 112(6): 1814-1823.
18.	孙云刚, 张强, 王朝, 等. 荧光法在单孔胸腔镜解剖性肺段切除术中识别段间交界线的可行性研究. 中国肺癌杂志, 2021, 24(11): 756-763.
19.	黄可南, 丁新宇, 陈昱, 等. 吲哚菁绿荧光胸腔镜技术在单孔胸腔镜下肺段切除术段间平面的识别. 中国胸心血管外科临床杂志, 2019, 26(6): 623-624.
20.	Chen X, Jin R, Xiang J, et al. Methods for dissecting intersegmental planes in segmentectomy: A randomized controlled trial. Ann Thorac Surg, 2020, 110(1): 258-264.
21.	Hong R, Chen C, Zheng W, et al. "Split" combined subsegmentectomy: A case series. Thorac Cancer, 2022, 13(3): 423-429.
22.	高永山, 张志杰, 付伟, 等. 单操作孔胸腔镜肺段切除治疗早期非小细胞肺癌的学习曲线. 中国微创外科杂志, 2021, 21(12): 1072-1076.
23.	Meacci E, Nachira D, Zanfrini E, et al. Uniportal VATS approach to sub-lobar anatomic resections: Literature review and personal experience. J Thorac Dis, 2020, 12(6): 3376-3389.

1. 黄晶晶, 陈志鹏, 卞承禹, 等. 以肺亚段为解剖单元的肺结节手术策略及临床结果的单中心回顾性分析. 中国胸心血管外科临床杂志, 2022, 29(1): 36-43.
2. Yoshimoto K, Nomori H, Mori T, et al. Combined subsegmentectomy: Postoperative pulmonary function compared to multiple segmental resection. J Cardiothorac Surg, 2011, 6: 17.
3. Nakamoto K, Omori K, Nezu K, et al. Superselective segmentectomy for deep and small pulmonary nodules under the guidance of three-dimensional reconstructed computed tomographic angiography. Ann Thorac Surg, 2010, 89(3): 877-883.
4. 梁志刚, 蒋连勇, 谢晓, 等. 经下肺韧带方向胸腔镜单向式肺后外基底段切除的应用. 中国胸心血管外科临床杂志, 2019, 26(12): 1176-1179.
5. 刘成武, 蒲强, 梅建东, 等. 单向式胸腔镜基底段切除术352例的单中心回顾性研究. 中国胸心血管外科临床杂志, 2022, 29(10): 1284-1289.
6. 陈昶, 朱余明, 姜格宁, 等. 肺段切除术和肺叶切除术治疗直径≤2 cm 且术中冰冻证实微乳头和实性亚型阴性肺腺癌的多中心随机对照研究. 中国胸心血管外科临床杂志, 2021, 28(11): 1292-1298.
7. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
8. Perez Holguin RA, Olecki EJ, Wong WG, et al. Outcomes after sublobar resection versus lobectomy in non-small cell carcinoma in situ. J Thorac Cardiovasc Surg, 2022, S0022-5223(22): 00627-4.
9. Wu W, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
10. 詹必成, 刘建, 陈剑, 等. 三维重建引导下胸腔镜扩大肺亚段切除术治疗肺段边缘结节. 中国微创外科杂志, 2021, 21(10): 904-907.
11. Hu W, Zhang K, Han X, et al. Three-dimensional computed tomography angiography and bronchography combined with three-dimensional printing for thoracoscopic pulmonary segmentectomy in stage ⅠA non-small cell lung cancer. J Thorac Dis, 2021, 13(2): 1187-1195.
12. 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.
13. 陈亮, 王俊, 吴卫兵, 等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 21-28.
14. Hagiwara M, Shimada Y, Kato Y, et al. High-quality 3-dimensional image simulation for pulmonary lobectomy and segmentectomy: Results of preoperative assessment of pulmonary vessels and short-term surgical outcomes in consecutive patients undergoing video-assisted thoracic surgery. Eur J Cardiothorac Surg, 2014, 46(6): e120-e126.
15. 陈剑, 刘建, 詹必成, 等. 肺动脉丝线结扎法在胸腔镜肺叶切除术中的应用. 中国胸心血管外科临床杂志, 2016, 23(5): 459-462.
16. Oizumi H, Kato H, Endoh M, et al. Management of bronchial stumps in anatomic lung segmentectomy. Ann Thorac Surg, 2016, 101(6): 2120-2124.
17. Yao F, Wu W, Zhu Q, et al. Thoracoscopic pulmonary segmentectomy with collateral ventilation method. Ann Thorac Surg, 2021, 112(6): 1814-1823.
18. 孙云刚, 张强, 王朝, 等. 荧光法在单孔胸腔镜解剖性肺段切除术中识别段间交界线的可行性研究. 中国肺癌杂志, 2021, 24(11): 756-763.
19. 黄可南, 丁新宇, 陈昱, 等. 吲哚菁绿荧光胸腔镜技术在单孔胸腔镜下肺段切除术段间平面的识别. 中国胸心血管外科临床杂志, 2019, 26(6): 623-624.
20. Chen X, Jin R, Xiang J, et al. Methods for dissecting intersegmental planes in segmentectomy: A randomized controlled trial. Ann Thorac Surg, 2020, 110(1): 258-264.
21. Hong R, Chen C, Zheng W, et al. "Split" combined subsegmentectomy: A case series. Thorac Cancer, 2022, 13(3): 423-429.
22. 高永山, 张志杰, 付伟, 等. 单操作孔胸腔镜肺段切除治疗早期非小细胞肺癌的学习曲线. 中国微创外科杂志, 2021, 21(12): 1072-1076.
23. Meacci E, Nachira D, Zanfrini E, et al. Uniportal VATS approach to sub-lobar anatomic resections: Literature review and personal experience. J Thorac Dis, 2020, 12(6): 3376-3389.

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Thoracoscopic combined subsegmentectomy for 76 patients: A retrospective study in a single center

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