Uniportal VATS S9 segmentectomy: The ligamentum-based approach

Area of Science:

• Thoracic surgery
• Pulmonary anatomy
• Surgical techniques

Background:

• Isolated resection of the lateral-basal segment (S9) is an uncommon and challenging anatomic segmentectomy.
• Difficulty arises from deep-seated segmental vascular supply within the lung parenchyma.
• The S9 segment's cuboidal shape complicates intersegmental plane identification.

Discussion:

• The fissure-based technique aids in identifying segmental arterial branches.
• A ligamentum-based approach is presented as a viable and safe alternative.
• This method is particularly useful when fissures are fused, obscuring landmarks.

Key Insights:

• Accurate identification of the intersegmental plane is crucial for safe S9 segmentectomy.
• The ligamentum-based approach provides a reliable method for surgical plane delineation.
• This technique enhances safety and feasibility in complex S9 resections.

Outlook:

• Further studies could explore the long-term outcomes of the ligamentum-based approach for S9 segmentectomy.
• Standardization of this technique may improve surgical precision and patient results.
• This approach could potentially be adapted for other complex segmentectomies.