Reverse watershed method applied to thoracoscopic S9 segmentectomy: a retrospective study

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Sublobar resection is preferred for early-stage non-small-cell lung cancer (NSCLC), especially tumors <2 cm.
• Identifying intersegmental planes is challenging in pulmonary segmentectomy, particularly for the S9 segment.
• Traditional methods for identifying segmental planes involve occluding individual segmental arteries or veins.

Purpose of the Study:

• To introduce and evaluate a novel technique, the reverse watershed method, for S9 segmentectomy.
• To compare the reverse watershed method with the modified inflation-collapse method for S9 resection.
• To assess the safety and efficacy of the reverse watershed method in terms of operative outcomes and postoperative recovery.

Main Methods:

• Retrospective analysis of 87 thoracoscopic S9 resections.
• Patients were divided into two groups: modified inflation-collapse method and reverse watershed method.
• Comparison of preoperative, intraoperative, and postoperative indicators between the two groups.

Main Results:

• The reverse watershed method group showed significantly reduced operative duration and intraoperative blood loss.
• Postoperative outcomes in the reverse watershed method group included a lower incidence of air leaks and reduced chest tube drainage volume and pain.
• No significant differences were found in chest tube retention duration, hospitalization length, or 3-month lung function.

Conclusions:

• The reverse watershed method is a safe and effective technique for S9 resection.
• This novel method offers advantages over the modified inflation-collapse technique, including shorter operative time and less bleeding.
• The reverse watershed method leads to improved postoperative recovery with reduced complications and comparable lung function preservation.