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.
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.