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Related Concept Videos

Endoscopic Studies I: Bronchoscopy and Thoracoscopy01:30

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Endoscopy is a non-surgical medical technique used to examine a person's internal organs and vessels. This lesson will focus on two types of endoscopic studies: bronchoscopy and thoracoscopy.
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...
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Reverse watershed method applied to thoracoscopic S9 segmentectomy: a retrospective study.

Jing Huang1,2, Jun Xu1,2, Zijian Li1,2

  • 1Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.

Journal of Cardiothoracic Surgery
|December 20, 2025
PubMed
Summary

The reverse watershed method for S9 resection in non-small-cell lung cancer (NSCLC) reduces operative time and bleeding. This technique also lowers air leak incidence, offering comparable lung function preservation to the modified inflation-collapse method.

Keywords:
Early-stage non-small-cell lung cancerIntersegmental planeS9 segmental resectionThoracoscopic surgery

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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.