[Thoracoscopic Right S6b+S8a+S9a Combined Subsegmentectomy for Small-sized Lung Cancer]

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Medical Imaging

Background:

• Early-stage lung cancer diagnosis and treatment present challenges for precise surgical resection.
• Sublobar resections are increasingly favored for small lung nodules to preserve lung function.
• Accurate identification of tumor location and surgical margins is critical for successful outcomes.

Observation:

• A 76-year-old male presented with a cough, and a 20 mm part-solid nodule in the right lower lobe was detected via computed tomography (CT).
• The nodule's location (S8a) adjacent to other segments (S6b, S9a) necessitated a complex resection strategy.
• Virtual-assisted lung mapping (VAL-MAP) using indocyanine green (ICG) was employed for preoperative marking and intraoperative guidance.

Findings:

• Thoracoscopic right S 6b+S 8a+S 9a combined subsegmentectomy was successfully performed.
• Intraoperative identification of the intersegmental plane was achieved using intravenous ICG, confirming the VAL-MAP guidance.
• Pathological diagnosis revealed invasive mucinous adenocarcinoma with no lymph node metastasis.

Implications:

• Combined subsegmentectomy is a viable and effective surgical option for treating small, early-stage lung cancers in specific locations.
• VAL-MAP with ICG facilitates precise localization and resection of lung nodules, potentially improving surgical accuracy and reducing invasiveness.
• This approach aids in lung cancer management by enabling targeted resection while preserving healthy lung tissue.