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Anatomical left S3 pulmonary segmentectomy using blunt dissection guided by video-assisted thoracic surgery.
Yasuji Terada1, Akihiro Aoyama2
1Department of General Thoracic Surgery, Misugikai Sato Hospital, Hirakata, Japan.
Multimedia Manual of Cardiothoracic Surgery : MMCTS
|January 10, 2025
Summary
Anatomically correct segmentectomy preserves lung function by dividing the segmental plane through blunt dissection. This technique avoids stapler-induced lung volume reduction and ensures proper inflation of residual lung segments.
Area of Science:
- Thoracic surgery
- Pulmonary anatomy
Background:
- Segmentectomy aims to preserve pulmonary parenchyma and function.
- Traditional stapler resection of central segments can lead to lung volume reduction and deformity.
Observation:
- The plane between pulmonary segments contains connective tissue and the pulmonary vein.
- Three-dimensional computed tomography confirms vessel and bronchi locations pre-operatively.
- Minimally invasive surgery involves a small skin incision and ports for scope and instruments.
Findings:
- Blunt dissection along the anatomically correct segmental plane preserves residual lung parenchyma.
- This method prevents compression and ensures full inflation of remaining lung segments without deformity.
- Accurate division of the segmental plane, with pulmonary vein confirmation, is crucial.
Implications:
- Anatomically correct segmentectomy by blunt dissection can maintain lung function effectively.
- This technique may eliminate the need for fibrin glue or biomaterial sheets.
- Properly divided intersegmental planes naturally close small air leaks, potentially reducing the need for sutures.
