Influence of intersegmental plane size and segment division methods on preserved lung volume and function after...

Area of Science:

• Thoracic surgery
• Pulmonary function analysis
• Surgical techniques

Background:

• Previous studies indicated stapler use for intersegmental plane division in segmentectomy did not compromise pulmonary volume or function compared to electrocautery.
• Concerns exist regarding potential compromises in lung volume and function preservation when staplers are used on larger intersegmental planes.

Purpose of the Study:

• To investigate the relationship between intersegmental plane size, preserved lung volume, and pulmonary function after segmentectomy.
• To compare these outcomes based on the method used for dividing intersegmental planes (stapler vs. electrocautery/mixed).

Main Methods:

• Computed tomography (CT) images from 56 patients were analyzed to semi-automatically calculate intersegmental plane sizes.
• Three-dimensional (3D) volumetry was used to determine the ratios of remnant segment (R-seg) and ipsilateral lung (R-ips) volumes, and postoperative pulmonary function relative to predicted values.
• Correlations between preserved lung volumes, pulmonary function, and intersegmental plane sizes were analyzed, stratified by division method (electrocautery/mixed vs. stapler alone).

Main Results:

• Intersegmental planes were divided using electrocautery/mixed methods in 21 patients and stapler alone in 35 patients.
• No significant difference in average intersegmental plane size was observed between the two groups.
• In the stapler-alone group, a negative correlation was found between intersegmental plane size and remnant segment volume (R-seg).

Conclusions:

• Increased intersegmental plane size correlated with decreased preserved remnant segmental volume when using the stapler method.
• The relationship between intersegmental plane size and preserved pulmonary function was not clearly established.
• The findings support the acceptability of stapler use, even for larger intersegmental planes during segmentectomy.