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

Hirohisa Kato1, Masami Abiko1, Kaito Sato1

  • 1Department of Thoracic Surgery, Okitama Public General Hospital, Yamagata, Japan.

Interdisciplinary Cardiovascular and Thoracic Surgery
|February 21, 2025
PubMed
Summary
This summary is machine-generated.

Identifying intersegmental vein points on the apical pleura simplifies upper lobe apical segmentectomy. The concave portion, especially in the left lung, is a reliable marker for this surgical division.

Keywords:
computed tomographyintersegmental lineintersegmental veinsegmentectomyvisceral pleura

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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.