Modified Posterior Approach in Thoracoscopic Lateral and Posterior Basal (S9 + 10) Segmentectomy for A9 + 10 and...

Area of Science:

• Thoracic Surgery
• Surgical Anatomy
• Minimally Invasive Procedures

Background:

• Posterior basal (S9+10) segmentectomy via posterior approach is beneficial for incomplete lobulation and patients with prior lung surgeries.
• Challenges include dissecting A9+10 and B9+10 in a narrow hilar surgical field.
• A modified posterior approach is introduced to overcome these difficulties.

Purpose of the Study:

• To present a modified posterior approach for thoracoscopic S9+10 segmentectomy.
• To demonstrate a technique that facilitates division of A9+10 and B9+10 in the hilar region.
• To improve surgical field visualization and safety during posterior basal segmentectomy.

Main Methods:

• Division of V9+10 and V7 (right-side surgery) in the hilum.
• Complete division of the intersegmental plane S6/S9+10 along V6b+c.
• Division of B9+10 and A9+10 in an improved surgical field.
• Identification and division of intersegmental planes S8/S9+10 and S7/S9+10 using indocyanine green fluorescence imaging.

Main Results:

• The modified approach provides a good surgical field for dividing hilar structures.
• Enables safe division of A9+10 and B9+10.
• Facilitates complete segmentectomy with enhanced visualization.

Conclusions:

• Dividing the S6/S9+10 intersegmental plane along V6b+c before A9+10 and B9+10 dissection is key.
• This modified posterior approach ensures a clear surgical field for thoracoscopic S9+10 segmentectomy.
• The technique enhances safety and efficiency in complex lung segment resections.