Identifying the intersegmental line using a concave portion during upper lobe apical segmentectomies.

Area of Science:

• Thoracic Surgery
• Anatomical Lung Resection
• Pulmonary Imaging

Background:

• The hilum approach for intersegmental division during apical segmentectomy is challenging, particularly with central vein types.
• Accurate identification of intersegmental planes is crucial for safe and effective anatomical lung resections.

Purpose of the Study:

• To explore the utility of the concave portion of the apical pleura as a landmark for simple intersegmental division.
• To evaluate the feasibility of using computed tomography (CT) images for identifying intersegmental vein peripheral points.

Main Methods:

• Retrospective evaluation of CT images from 175 patients undergoing anatomical lung resection (June 2020 - April 2024).
• Classification of upper pulmonary vein branching patterns into apical, apico-central, and central vein types.
• Assessment of intersegmental vein peripheral point locations (left V1+2a or right V1b) on apical pleural portions (anterior-convex, concave, apical-convex) using 3D CT.

Main Results:

• Peripheral intersegmental vein points were consistently found in the anterior-convex, concave, and apical-convex portions of the apical pleura.
• In the left lung, points concentrated in the concave portion (60.9%); in the right lung, points concentrated in the anterior-convex portion (67.2%).
• Notably, 100% of central vein type cases in the left lung showed peripheral points in the concave portion, a tendency not observed in the right lung.

Conclusions:

• Peripheral intersegmental points are concentrated on the apical pleura, particularly within the concave portion.
• The concave portion of the apical pleura, especially in the left lung, serves as a practical and reliable landmark for intersegmental line marking during upper segmentectomy.