Objective To verify the feasibility and accuracy of the "lung surface intersegmental constant proportion landmarks", developed by our center, in identifying intersegmental planes during pulmonary segmentectomy. MethodsWe prospectively enrolled the patients who planned to receive thoracoscopic segmentectomy in West China Hospital of Sichuan University and The Third People's Hospital of Chengdu from September 2021 to October 2021. We took a relatively objective and feasible method, intravenous injection of indocyanine green, in identifying intersegmental planes as standard control. We intraoperatively judged the consistency between "lung surface intersegmental constant proportion landmarks" and intravenous injection of indocyanine green in identifying intersegmental planes. We discerned main landmarks of intersegmental plane by the constant proportion segment module, which was built based on the "lung surface intersegmental constant proportion landmarks", as well as distinguished the planes with discrepant fluorescence by peripheral intravenous indocyanine green injection. When the distance between the landmarks determined by the "ung surface intersegmental constant proportion landmarks" and the segmental boundaries displayed by indocyanine green fluorescence staining was ≤1 cm, the landmarks were judged to be consistent with the planes with discrepant fluorescence. As long as one of the landmarks was judged to be consistent, the method was considered to be feasible and accurate. Results A total of 21 patients who underwent thoracoscopic segmentectomy were enrolled, with 5 male and 16 female patients. The median age was 55 years, ranging from 34 to 76 years. A total of 11 patients received left-side surgery, while 10 patients received right-side surgery. In the operations of 21 pulmonary segmentectomies, at least one intersegmental landmark determined by the "lung surface intersegmental constant proportion landmarks" was consistent with the intersegmental plane determined by indocyanine green fluorescence staining in each patient. ConclusionThe intersegmental landmarks determined by the "lung surface intersegmental constant proportion landmarks" are consistent with that determined by indocyanine green fluorescence staining. The method of "lung surface intersegmental constant proportion landmarks" is feasible and accurate in identifying intersegmental planes during pulmonary segmentectomy.
ObjectiveTo evaluate the curative and economic effect of da Vinci robotic lung segmentectomy. MethodWe retrospectively analyzed clinical data of 13 patients who underwent robotic lung segmentectomy (as a robotic group) and 35 patients who underwent thoracoscopic lung segmentectomy (as a thoracoscopic group) in our hospital between September 2014 and April 2015. There were 4 males and 9 females at age of 43-73 (59.1±8.9) years in the robot group and 17 males and 18 females in the thoracoscopic group at age of 30-79 (59.1+12.0) years. Effects of the two groups were compared. ResultsPostoperative hospitalization time in the robotic group was shorter than that in the thoracoscopic group (4.4±0.8 d vs. 6.3±2.5 d, P<0.05). But the cost of hospitalization in the robotic group was higher than that in the thoracoscopic group (P<0.05). The surgery indwelling catheter time and incidence of complications in the robotic group were lower than those in the thoracoscopic group with no statistical difference (P=0.053, 0.081). ConclusionRobotic lung segmentectomy is a safe and feasible operation method. With the further accumulation of clinical experience and decrease of the cost of materials, the robot will play a more important role in the future of minimally invasive thoracic surgery.
With the development of precision diagnosis and treatment of lung cancer, anatomical segmentectomy has become an important surgical procedure for the treatment of early-stage lung cancer. After the widespread popularization of video-assisted thoracoscopic surgery (VATS), the treatment of lung cancer has entered the era of minimally invasive surgery. Since it was first reported in 2012, uniportal video-assisted anatomical segmentectomy has gained increasing clinical application. Uniportal VATS is less invasive than thoracotomy and traditional VATS. At present, the main research hotspots around uniportal video-assisted anatomical segmentectomy include specific indications, short-term and long-term efficacy, and learning curve. This article will introduce the characteristics, indications and surgical techniques of this procedure, then summarize and discuss the latest research progress of uniportal video-assisted anatomical segmentectomy based on the latest evidence-based evidence.
Abstract： Objective To evaluate the safety and efficacy of total thoracoscopic anatomic pulmonary segmentectomy for the treatment of early-stage peripheral lung carcinoma, pulmonary metastases and benign pulmonary diseases. Methods We retrospectively analyzed 20 patients who received total thoracoscopic anatomic pulmonary segmentectomy in Zhongshan Hospital of Fudan University from March 2008 to November 2011. There were ten male and ten female patients with a mean age of 58.0（14-86）years. Three ports were used. The pulmonary artery and vein of the segment were dealt with Hem-o-lok or stapler. The bronchi of the segment were dealt with staplers. Staplers were used in peripheral lung of intersegmental plane. Results All the twenty patients underwent total thoracoscopic anatomic segmentectomy successfully without any conversion to thoracoctomy or lobectomy. No perioperative morbidity or mortality occurred. Postoperative pathological examinations showed lung cancer in 10 patients, pulmonary metastases in 3 patients and benign pulmonary diseases in 7 patients. The mean operative time was 133.0（90-240）min. The mean blood loss was 85.0（50-200）ml. The chest tubes were maintained in position for 3.2 （2-7） d. The mean postoperative hospitalization time was 6.7 （4-11）d. Conclusion Total thoracoscopic anatomic pulmonary segmentectomy is a feasible and safe technique to be used selectively for Ⅰa stage lung cancer, pulmonary metastases and benign pulmonary diseases that are not appropriate for wedge resection.
Objective To evaluate the survival outcomes of segmentectomy versus lobectomy for T1c non-small cell lung cancer (NSCLC). Methods We searched PubMed, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), CNKI (China National Knowledge Infrastructure), and Wanfang Data, with the search time limit set from the inception of the databases to February 2024. Three researchers independently screened the literature, extracted relevant information, and evaluated the risk of bias of the included literature according to the Newcastle-Ottawa Scale (NOS). Meta-analysis was conducted using STATA 15.1. Results A total of 8 retrospective cohort studies were included, involving 7 433 patients. The NOS scores of the included studies were all ≥7 points. Patients who underwent lobectomy had significantly higher five-year overall survival (OS) rates compared to those who underwent segmentectomy (adjusted HR=1.11, 95%CI 0.99-1.24, P=0.042). Compared with lobectomy, segmentectomy showed no significant difference in adjusted three-year OS rate (adjusted HR=0.88, 95%CI 0.62-1.24) and adjusted five-year lung cancer-specific survival (adjusted HR=1.10, 95%CI 0.80-1.51, P=0.556) of patients with T1c NSCLC. Moreover, there were no differences in the five-year adjusted relapse-free survival (adjusted HR=1.23, 95%CI 0.82-1.85, P=0.319), and adverse events (OR=0.57, 95%CI 0.37-0.90, P=0.015) in the segmentectomy group were significantly less than those in the lobectomy group. Subgroup analysis based on whether patients received neoadjuvant therapy showed that among studies that excluded patients who received neoadjuvant therapy, no significant difference in 5-year adjusted OS rate was observed between the segmentectomy group and lobectomy group (adjusted HR=1.02, 95%CI 0.81-1.28, P=0.870). Conclusion Segmentectomy and lobectomy show no significant difference in long-term survival in stage T1c NSCLC patients, with segmentectomy associated with fewer postoperative complications. Further high-quality research is needed to con?rm the comparative ef?cacy and safety of lobectomy and segmentectomy for T1c NSCLC patients.
With the wide popularization of low-dose computed tomography screening for lung cancer, the proportion of early detection of lung cancer has increased significantly. Due to the favorable prognosis of ground-glass nodule-lung cancer, a prospective multicenter clinical trial in Japan has confirmed the safety and efficacy of segmentectomy. Identification of the intersegmental plane is one of the key steps in segmentectomy. Understanding its physiological mechanism can provide a theoretical basis for optimizing the identification technique, identifying intersegmental plane more accurately and quickly, improving the surgical effect and reducing complications. This article mainly introduces the identification technology of the intersegmental plane and its physiological mechanism in pulmonary segmentectomy.
ObjectiveTo compare the clinical application of empirical thoracoscopic segmentectomy and precise segmentectomy planned by artificial intelligence software, and to provide some reference for clinical segmentectomy. MethodsA retrospective analysis was performed on the patients who underwent thoracoscopic segmentectomy in our department from 2019 to 2022. The patients receiving empirical thoracoscopic segmentectomy from January 2019 to September 2021 were selected as a group A, and the patients receiving precise segmentectomy from October 2021 to December 2022 were selected as a group B. The number of preoperative Hookwire positioning needle, proportion of patients meeting oncology criteria, surgical time, intraoperative blood loss, postoperative chest drainage time, postoperative hospital stay, and number of patients converted to thoracotomy between the two groups were compared. Results A total of 322 patients were collected. There were 158 patients in the group A, including 56 males and 102 females with a mean age of 56.86±8.82 years, and 164 patients in the group B, including 55 males and 109 females with a mean age of 56.69±9.05 years. All patients successfully underwent thoracoscopic segmentectomy, and patients whose resection margin did not meet the oncology criteria were further treated with extended resection or even lobectomy. There was no perioperative death. The number of positioning needles used for segmentectomy in the group A was more than that in the group B [47 (29.7%) vs. 9 (5.5%), P<0.001]. There was no statistical difference in the number of positioning needles used for wedge resection between the two groups during the same period (P=0.572). In the group A, the nodule could not be found in the resection target segment in 3 patients, and the resection margin was insufficient in 10 patients. While in the group B, the nodule could not be found in 1 patient, and the resection margin was insufficient in 3 patients. There was a statistical difference between the two groups [13 (8.2%) vs. 4 (2.4%), P=0.020]. There was no statistical difference between the two groups in terms of surgical time, intraoperative blood loss, duration of postoperative thoracic drainage, postoperative hospital stay, or conversion to open chest surgery (P＞0.05). Conclusion Preoperative surgical planning performed with the help of artificial intelligence software can effectively guide the completion of thoracoscopic anatomical segmentectomy. It can effectively ensure the resection margin of pulmonary nodules meeting the oncological requirements and significantly reduce the number of positioning needles of pulmonary nodules.