Uniportal video-assisted thoracoscopic left superior segmentectomy.

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Achieving adequate margins in lung cancer resection is critical for patient outcomes.
• Thoracoscopic segmentectomy requires precise identification of intersegmental planes, especially when tumors are not palpable.
• Uniportal video-assisted thoracoscopic (VATS) surgery offers minimally invasive options for lung resections.

Observation:

• The inflation-deflation method, while common, can lead to unreliable intersegmental plane identification due to collateral ventilation.
• The inflation-deflation technique can also compromise working space during VATS procedures due to lung expansion.
• Selective resected segmental inflation allows for targeted expansion of the target segment, optimizing surgical visualization.

Findings:

• Selective resected segmental inflation provides a more reliable and optimal surgical space during VATS segmentectomy.
• The inflation-deflation method's unreliability stems from collateral ventilation, potentially impacting oncological outcomes.
• Directly inflating the target segmental bronchus ensures clear demarcation of the intersegmental plane.

Implications:

• Precise intersegmental plane identification is paramount for achieving satisfactory oncological and surgical results in thoracoscopic segmentectomy.
• Inadequate plane demarcation can lead to locoregional recurrence and negatively impact long-term survival.
• Efforts to optimize intersegmental plane identification techniques are essential for improving VATS segmentectomy success rates.