The AMAGAMI technique: an easy technique to achieve precise stapling in thoracoscopic segmentectomy

Area of Science:

• Thoracic Surgery
• Surgical Techniques
• Minimally Invasive Surgery

Background:

• Thoracoscopic segmentectomy presents challenges due to limited visualization and instrument access.
• Precise stapling is crucial but difficult in confined surgical fields.
• Existing techniques may not adequately address complex staple line requirements.

Purpose of the Study:

• To introduce and describe the AMAGAMI technique for lung segmentectomy.
• To highlight the utility of standing stitches in conjunction with the AMAGAMI technique.
• To demonstrate the applicability of these methods in challenging thoracoscopic surgeries.

Main Methods:

• The AMAGAMI technique involves using an unlocked stapler to grasp lung tissue, which is then repositioned using forceps.
• Standing stitches, placed along pre-determined intersegmental lines (e.g., from virtual-assisted lung mapping), are used for visualization.
• Monofilament sutures, approximately 1 cm long, are employed for standing stitches to ensure visibility.

Main Results:

• The AMAGAMI technique allows for precise positioning of lung tissue for stapling, overcoming limitations of direct stapler manipulation.
• Standing stitches provide clear visualization of the intended resection line, even from tangential angles.
• These methods facilitate complex staple lines, such as in S10 segmentectomy, and are beneficial in uniportal thoracoscopic surgery.

Conclusions:

• The AMAGAMI technique, combined with standing stitches, offers an effective solution for precise lung segment resection in thoracoscopic surgery.
• This approach enhances surgical precision and safety, particularly in procedures with limited access or complex anatomical requirements.
• The described methods represent valuable advancements for thoracic surgeons performing minimally invasive lung resections.