Using novel technology to augment complex video-assisted thoracoscopic single basilar segmentectomy

There are many novel technologies that enable complex segmentectomy to be performed. As lung cancer screening becomes more prevalent, patients are increasingly diagnosed with early stage lung cancer, multifocal disease, and second primary tumors. This shift to an earlier clinical presentation combined with advances in technology and an emphasis on minimally invasive techniques have led to the current developments we are now seeing with anatomic segmentectomy. In this paper, we describe the operative technique of an indocyanine green (ICG)-guided video-assisted thoracoscopic surgery (VATS) single basilar segmental resection, augmented with methylene blue dye marker localization via SuperDimension electromagnetic navigational bronchoscopy. The CT scans of the posterior basal segment tumor are enhanced with three-dimensional (3D) modeling. A description of the approach is detailed with a video, intraoperative photographs, and illustrations. Successful removal of the S¹⁰ segment with novel techniques permitted the patient to have five percent of the lung removed (segmentectomy) instead of 25% (right lower lobectomy). In the setting of multifocal disease, future treatment options for the tumors in other locations of the lung are enhanced. Novel lung imaging techniques along with careful intraoperative identification of appropriate segmental anatomy allow patients to be offered an optimal basilar parenchymal-sparing segmentectomy.