The arterial-ligation-alone method for identifying the intersegmental plane during thoracoscopic anatomic...

Area of Science:

• Thoracic Surgery
• Surgical Anatomy
• Pulmonary Medicine

Background:

• Identifying the intersegmental plane in anatomical segmentectomy traditionally uses bronchial or vascular methods.
• The arterial-ligation-alone vascular method lacks validation in large patient cohorts.
• This study aimed to validate the arterial-ligation-alone method for accurate intersegmental plane identification.

Purpose of the Study:

• To confirm the effectiveness and accuracy of the arterial-ligation-alone method for identifying the intersegmental plane.
• To evaluate the arterial-ligation-alone method in a large series of patients undergoing thoracoscopic anatomic segmentectomy.

Main Methods:

• Retrospective review of 104 patients undergoing thoracoscopic anatomic segmentectomy.
• Preoperative 3D reconstruction for segmental artery, vein, and bronchus identification.
• Ligation of segmental arteries, followed by ventilation, to identify the first intersegmental plane (T1).
• Subsequent ligation of segmental veins and bronchi, followed by inflation-deflation, to identify the second intersegmental plane (T2).
• Comparison of planes identified by the two methods by experienced thoracic surgeons.

Main Results:

• The arterial-ligation-alone method successfully and accurately identified intersegmental planes in 99 (95.2%) patients.
• Eighty-five (81.7%) patients underwent successful thoracoscopic anatomic segmentectomy.
• Intersegmental planes were completely consistent in 94.9% and basically consistent in 5.1% of cases.
• Mean T1 was 13.6±2.7 minutes and mean T2 was 13.0±2.6 minutes (P=0.100).
• Low complication rate (2 cases) and favorable surgical outcomes including margin width and operative duration.

Conclusions:

• The arterial-ligation-alone method is an effective, accurate, and inexpensive technique for identifying the intersegmental plane.
• This method is particularly advantageous for patients with challenging venous or bronchial anatomy.
• Ligation of the target bronchus does not influence the accuracy of intersegmental plane identification using this vascular approach.