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A proposal for selecting appropriate intersegmental plane identification methods based on tumor characteristics in
1Department of Thoracic Surgery, Okitama Public General Hospital, Yamagata, Japan.
Journal of Visualized Surgery
|August 13, 2026
Summary
Accurate identification of the intersegmental plane (ISP) is crucial for anatomical segmentectomy. The best method depends on tumor characteristics, with near-infrared fluorescence imaging and traditional techniques offering options for precise surgical planning.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Accurate identification of the intersegmental plane (ISP) is essential for successful anatomical segmentectomy.
- Current methods for ISP identification include traditional techniques and newer fluorescence imaging, but the optimal approach remains debated.
Purpose of the Study:
- To review and compare various intersegmental plane identification methods for anatomical segmentectomy.
- To provide guidance on selecting the most appropriate ISP identification technique based on tumor characteristics.
Main Methods:
- Review of traditional methods: intersegmental veins and inflation-deflation lines.
- Evaluation of near-infrared fluorescence imaging with indocyanine green (ICG) injection.
- Introduction of a novel method using the concave portion of the apical visceral pleura.
Main Results:
- ISP identification methods should be tailored to tumor characteristics (e.g., ground-glass opacity, solid nodules).
- For detectable tumors, ICG or apical structure demarcation allows confirmation of distance for adequate margins.
- For undetectable tumors, precise ISP identification requires combining ICG, intersegmental veins, and inflation-deflation.
Conclusions:
- The choice of ISP identification method in segmentectomy should be based on a careful assessment of tumor detectability and location.
- A combination of techniques may be necessary for optimal surgical margin achievement, particularly for tumors that are not easily detectable during surgery.
