Thoracoscopic combined subsegmentectomy for 76 patients: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAN Bicheng ,  LIU Jian , CHEN Jian , LIU Yongzhi , LI Genshui , GUO Kunliang , WANG Xiao , XIONG Yanzheng , GU Mingbo

Department of Cardiothoracic Surgery, Anqing Municipal Hospital, Anqing Medical Center of Anhui Medical University, Anqing, 246003, Anhui, P. R. China;

Corresponding?author：

LIU Jian, Email: liujianaqslyy@126.com

Keywords：

Thoracoscopy; minimally invasive; combined subsegmentectomy

DOI：

10.7507/1007-4848.202207076

Video：

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Objective To summarize the clinical experience of thoracoscopic combined subsegmentectomy (CSS). Methods The clinical data of 76 patients who underwent thoracoscopic CSS in Anqing Municipal Hospital from May 2018 to July 2022 were retrospectively analyzed, including 22 males and 54 females, aged 27.0-76.0 (54.3±10.5) years. All patients underwent preoperative three-dimensional computed tomography bronchography and angiography using dual source CT. The modified inflation-deflation technique or indocyanine green was used to identify the intersubsegmental border. Results A total of 86 pulmonary nodules were resected in 76 patients. One patient of left upper lobe S¹⁺²c+S⁴a, 1 patient of right upper lobe S²b+S³a and 1 patient of right upper lobe S¹b+S³b were further performed lobectomy due to insufficient margin. One patient of left upper lobe S¹⁺²+S³a was further performed left upper division segmentectomy due to residual atelectasis. One patient of left upper lobe S¹⁺²c+S³a was further performed left upper division segmentectomy due to B³b+c injury, and the rest completed planned surgeries successfully. The operative time was 90.0-350.0 (174.9±53.2) min. The operative hemorrhage volume was 50.0 (20.0, 50.0) mL. The postoperative hospital stay time was 6.0 (5.0, 7.0) d. Postoperative complications included pulmonary infection in 9 patients, hemoptysis in 3 patients, persistent pulmonary leakage>3 d in 4 patients, pneumothorax in 1 patient, pleural effusion in 1 patient, and myocardial infarction in 1 patient. All of the patients were cured and discharged without perioperative death. Conclusion Thoracoscopic CSS is relatively complex. Preoperative planning under three-dimensional reconstruction and intraoperative fine operation are helpful for safe completion.

Citation： ZHAN Bicheng, LIU Jian, CHEN Jian, LIU Yongzhi, LI Genshui, GUO Kunliang, WANG Xiao, XIONG Yanzheng, GU Mingbo. Thoracoscopic combined subsegmentectomy for 76 patients: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 47-51. doi: 10.7507/1007-4848.202207076 Copy

1.	黃晶晶, 陳志鵬, 卞承禹, 等. 以肺亞段為解剖單元的肺結節手術策略及臨床結果的單中心回顧性分析. 中國胸心血管外科臨床雜志, 2022, 29(1): 36-43.
2.	Yoshimoto K, Nomori H, Mori T, et al. Combined subsegmentectomy: Postoperative pulmonary function compared to multiple segmental resection. J Cardiothorac Surg, 2011, 6: 17.
3.	Nakamoto K, Omori K, Nezu K, et al. Superselective segmentectomy for deep and small pulmonary nodules under the guidance of three-dimensional reconstructed computed tomographic angiography. Ann Thorac Surg, 2010, 89(3): 877-883.
4.	梁志剛, 蔣連勇, 謝曉, 等. 經下肺韌帶方向胸腔鏡單向式肺后外基底段切除的應用. 中國胸心血管外科臨床雜志, 2019, 26(12): 1176-1179.
5.	劉成武, 蒲強, 梅建東, 等. 單向式胸腔鏡基底段切除術352例的單中心回顧性研究. 中國胸心血管外科臨床雜志, 2022, 29(10): 1284-1289.
6.	陳昶, 朱余明, 姜格寧, 等. 肺段切除術和肺葉切除術治療直徑≤2 cm 且術中冰凍證實微乳頭和實性亞型陰性肺腺癌的多中心隨機對照研究. 中國胸心血管外科臨床雜志, 2021, 28(11): 1292-1298.
7.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
8.	Perez Holguin RA, Olecki EJ, Wong WG, et al. Outcomes after sublobar resection versus lobectomy in non-small cell carcinoma in situ. J Thorac Cardiovasc Surg, 2022, S0022-5223(22): 00627-4.
9.	Wu W, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
10.	詹必成, 劉建, 陳劍, 等. 三維重建引導下胸腔鏡擴大肺亞段切除術治療肺段邊緣結節. 中國微創外科雜志, 2021, 21(10): 904-907.
11.	Hu W, Zhang K, Han X, et al. Three-dimensional computed tomography angiography and bronchography combined with three-dimensional printing for thoracoscopic pulmonary segmentectomy in stage ⅠA non-small cell lung cancer. J Thorac Dis, 2021, 13(2): 1187-1195.
12.	Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique: Selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
13.	陳亮, 王俊, 吳衛兵, 等. 胸腔鏡精準肺段切除術技術流程和質量控制. 中國胸心血管外科臨床雜志, 2019, 26(1): 21-28.
14.	Hagiwara M, Shimada Y, Kato Y, et al. High-quality 3-dimensional image simulation for pulmonary lobectomy and segmentectomy: Results of preoperative assessment of pulmonary vessels and short-term surgical outcomes in consecutive patients undergoing video-assisted thoracic surgery. Eur J Cardiothorac Surg, 2014, 46(6): e120-e126.
15.	陳劍, 劉建, 詹必成, 等. 肺動脈絲線結扎法在胸腔鏡肺葉切除術中的應用. 中國胸心血管外科臨床雜志, 2016, 23(5): 459-462.
16.	Oizumi H, Kato H, Endoh M, et al. Management of bronchial stumps in anatomic lung segmentectomy. Ann Thorac Surg, 2016, 101(6): 2120-2124.
17.	Yao F, Wu W, Zhu Q, et al. Thoracoscopic pulmonary segmentectomy with collateral ventilation method. Ann Thorac Surg, 2021, 112(6): 1814-1823.
18.	孫云剛, 張強, 王朝, 等. 熒光法在單孔胸腔鏡解剖性肺段切除術中識別段間交界線的可行性研究. 中國肺癌雜志, 2021, 24(11): 756-763.
19.	黃可南, 丁新宇, 陳昱, 等. 吲哚菁綠熒光胸腔鏡技術在單孔胸腔鏡下肺段切除術段間平面的識別. 中國胸心血管外科臨床雜志, 2019, 26(6): 623-624.
20.	Chen X, Jin R, Xiang J, et al. Methods for dissecting intersegmental planes in segmentectomy: A randomized controlled trial. Ann Thorac Surg, 2020, 110(1): 258-264.
21.	Hong R, Chen C, Zheng W, et al. "Split" combined subsegmentectomy: A case series. Thorac Cancer, 2022, 13(3): 423-429.
22.	高永山, 張志杰, 付偉, 等. 單操作孔胸腔鏡肺段切除治療早期非小細胞肺癌的學習曲線. 中國微創外科雜志, 2021, 21(12): 1072-1076.
23.	Meacci E, Nachira D, Zanfrini E, et al. Uniportal VATS approach to sub-lobar anatomic resections: Literature review and personal experience. J Thorac Dis, 2020, 12(6): 3376-3389.

1. 黃晶晶, 陳志鵬, 卞承禹, 等. 以肺亞段為解剖單元的肺結節手術策略及臨床結果的單中心回顧性分析. 中國胸心血管外科臨床雜志, 2022, 29(1): 36-43.
2. Yoshimoto K, Nomori H, Mori T, et al. Combined subsegmentectomy: Postoperative pulmonary function compared to multiple segmental resection. J Cardiothorac Surg, 2011, 6: 17.
3. Nakamoto K, Omori K, Nezu K, et al. Superselective segmentectomy for deep and small pulmonary nodules under the guidance of three-dimensional reconstructed computed tomographic angiography. Ann Thorac Surg, 2010, 89(3): 877-883.
4. 梁志剛, 蔣連勇, 謝曉, 等. 經下肺韌帶方向胸腔鏡單向式肺后外基底段切除的應用. 中國胸心血管外科臨床雜志, 2019, 26(12): 1176-1179.
5. 劉成武, 蒲強, 梅建東, 等. 單向式胸腔鏡基底段切除術352例的單中心回顧性研究. 中國胸心血管外科臨床雜志, 2022, 29(10): 1284-1289.
6. 陳昶, 朱余明, 姜格寧, 等. 肺段切除術和肺葉切除術治療直徑≤2 cm 且術中冰凍證實微乳頭和實性亞型陰性肺腺癌的多中心隨機對照研究. 中國胸心血管外科臨床雜志, 2021, 28(11): 1292-1298.
7. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
8. Perez Holguin RA, Olecki EJ, Wong WG, et al. Outcomes after sublobar resection versus lobectomy in non-small cell carcinoma in situ. J Thorac Cardiovasc Surg, 2022, S0022-5223(22): 00627-4.
9. Wu W, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
10. 詹必成, 劉建, 陳劍, 等. 三維重建引導下胸腔鏡擴大肺亞段切除術治療肺段邊緣結節. 中國微創外科雜志, 2021, 21(10): 904-907.
11. Hu W, Zhang K, Han X, et al. Three-dimensional computed tomography angiography and bronchography combined with three-dimensional printing for thoracoscopic pulmonary segmentectomy in stage ⅠA non-small cell lung cancer. J Thorac Dis, 2021, 13(2): 1187-1195.
12. Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique: Selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
13. 陳亮, 王俊, 吳衛兵, 等. 胸腔鏡精準肺段切除術技術流程和質量控制. 中國胸心血管外科臨床雜志, 2019, 26(1): 21-28.
14. Hagiwara M, Shimada Y, Kato Y, et al. High-quality 3-dimensional image simulation for pulmonary lobectomy and segmentectomy: Results of preoperative assessment of pulmonary vessels and short-term surgical outcomes in consecutive patients undergoing video-assisted thoracic surgery. Eur J Cardiothorac Surg, 2014, 46(6): e120-e126.
15. 陳劍, 劉建, 詹必成, 等. 肺動脈絲線結扎法在胸腔鏡肺葉切除術中的應用. 中國胸心血管外科臨床雜志, 2016, 23(5): 459-462.
16. Oizumi H, Kato H, Endoh M, et al. Management of bronchial stumps in anatomic lung segmentectomy. Ann Thorac Surg, 2016, 101(6): 2120-2124.
17. Yao F, Wu W, Zhu Q, et al. Thoracoscopic pulmonary segmentectomy with collateral ventilation method. Ann Thorac Surg, 2021, 112(6): 1814-1823.
18. 孫云剛, 張強, 王朝, 等. 熒光法在單孔胸腔鏡解剖性肺段切除術中識別段間交界線的可行性研究. 中國肺癌雜志, 2021, 24(11): 756-763.
19. 黃可南, 丁新宇, 陳昱, 等. 吲哚菁綠熒光胸腔鏡技術在單孔胸腔鏡下肺段切除術段間平面的識別. 中國胸心血管外科臨床雜志, 2019, 26(6): 623-624.
20. Chen X, Jin R, Xiang J, et al. Methods for dissecting intersegmental planes in segmentectomy: A randomized controlled trial. Ann Thorac Surg, 2020, 110(1): 258-264.
21. Hong R, Chen C, Zheng W, et al. "Split" combined subsegmentectomy: A case series. Thorac Cancer, 2022, 13(3): 423-429.
22. 高永山, 張志杰, 付偉, 等. 單操作孔胸腔鏡肺段切除治療早期非小細胞肺癌的學習曲線. 中國微創外科雜志, 2021, 21(12): 1072-1076.
23. Meacci E, Nachira D, Zanfrini E, et al. Uniportal VATS approach to sub-lobar anatomic resections: Literature review and personal experience. J Thorac Dis, 2020, 12(6): 3376-3389.

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Thoracoscopic combined subsegmentectomy for 76 patients: A retrospective study in a single center

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