Identification of the intersegmental plane by arterial ligation method during thoracoscopic segmentectomy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Thoracoscopic segmentectomy is a standard thoracic surgical procedure.
• Accurate identification of the intersegmental plane is crucial but challenging.
• This study investigates a novel arterial ligation method for intersegmental plane demarcation.

Purpose of the Study:

• To evaluate the feasibility of the arterial ligation method for identifying the intersegmental plane in thoracoscopic segmentectomy.
• To compare the accuracy of the arterial ligation method with intravenous indocyanine green (ICG) fluorescence for intersegmental plane demarcation.
• To assess the safety and efficiency of the arterial ligation method in clinical practice.

Main Methods:

• Retrospective review of 35 patients undergoing thoracoscopic segmentectomy for peripheral small lung nodules.
• Preoperative 3D reconstruction to identify anatomical structures and nodule locations.
• Arterial ligation followed by inflation-deflation technique to determine the intersegmental plane, with recording of waiting time.
• Comparison of the intersegmental plane identified by arterial ligation with that identified by ICG fluorescence.

Main Results:

• The arterial ligation method successfully identified the intersegmental plane in all patients.
• The planes identified by arterial ligation and ICG fluorescence were comparable, with a maximum difference of 5 mm.
• Mean operative duration was 119.1 minutes, with a mean blood loss of 76.9 ml. Postoperative outcomes included one prolonged air leak and no atelectasis.
• The waiting time for the intersegmental plane appearance via arterial ligation was 13.7 ± 3.2 minutes.

Conclusions:

• The arterial ligation method is an efficient and accurate technique for identifying the intersegmental plane in thoracoscopic segmentectomy.
• This method provides comparable results to the ICG fluorescence method.
• Arterial ligation serves as a valuable tool for precise lung segment resections.