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Determination of the intersegmental plane using the slip-knot method.

Makoto Endoh1, Hiroyuki Oizumi1, Hirohisa Kato1

  • 1Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata City 990-9585, Yamagata Prefecture, Japan.

Journal of Thoracic Disease
|May 23, 2018
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Summary

The slip-knot method effectively visualizes lung intersegmental planes for anatomical segmentectomy. This technique facilitates precise thoracoscopic pulmonary segmentectomy with good adaptation in most patients.

Keywords:
Lung cancersegmentectomyvideo-assisted thoracic surgery

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Area of Science:

  • Thoracic Surgery
  • Pulmonary Anatomy
  • Surgical Techniques

Background:

  • Precise visualization of intersegmental planes is crucial for anatomical lung segmentectomy.
  • The slip-knot method was developed to create inflation-deflation lines for improved visualization.
  • This study evaluates the efficacy of the slip-knot method in thoracoscopic segmentectomy.

Purpose of the Study:

  • To assess the data relevant to thoracoscopic segmentectomy using the slip-knot method.
  • To determine the adaptability and effectiveness of the slip-knot technique in visualizing intersegmental planes.
  • To evaluate the outcomes of thoracoscopic segmentectomy performed with this method.

Main Methods:

  • The slip-knot method involves looping the segmental bronchus with a monofilament thread.
  • Pulling the thread during ventilation creates a knot that blocks segmental air outflow, causing the target segment to expand.
  • Data from 221 patients undergoing thoracoscopic pulmonary segmentectomy (2010-2016) were analyzed.

Main Results:

  • The slip-knot method was indicated in 147 patients (67%), with 96% showing good adaptation.
  • Excellent inflation-deflation line images were obtained, facilitating intersegmental plane determination.
  • Mean operative time was 171±51 min, and mean chest tube duration was 1.5±1.2 days, with low rates of air leakage (2.0% prolonged, 0.7% readmission).

Conclusions:

  • The slip-knot method allows for anatomical intersegmental plane determination using a single monofilament thread.
  • This technique simplifies and facilitates thoracoscopic pulmonary anatomical segmentectomy.
  • The method is effective and safe for guiding precise lung segment resection.