Video-Atlas of VATS Pulmonary Sublobar Resections

Prologue
Contents
Part I: General Considerations and Technical Aspects
1: Indications for Sublobar Resection in the Treatment of Non-Small Cell Lung Cancer (NSCLC)
1.1 Introduction
1.2 Elective Sublobar Resection
1.2.1 Short- and Intermediate-Term Outcomes
1.2.2 Long-Term Outcomes for Ground Glass Tumors
1.2.3 Long-Term Outcomes for Small (≤2 cm) Solid Tumors
1.2.4 Decision-Making for Elective Sublobar Resection
1.3 Compromise Sublobar Resection
1.3.1 Older Patients
1.3.1.1 Short- and Intermediate-Term Outcomes
1.3.1.2 Long-Term Outcomes
1.3.2 Patients with Limited Pulmonary Reserve
1.3.2.1 Short- and Intermediate-Term Outcomes
1.3.2.2 Long-Term Outcomes
1.3.3 Decision-Making for Compromise Sublobar Resection
1.4 Technical Issues
1.4.1 Anatomic Location
1.4.2 Resection Margin
1.4.3 Spread Through Air Spaces (STAS)
1.5 Conclusion
References
2: Anatomical and Radiological Correlation
2.1 Introduction
2.2 Preoperative Radiological Techniques
2.3 Understanding Segmental Anatomy at CT
2.4 Segmental Anatomy by Lobe
2.5 Right Upper Lobe
2.6 Middle Lobe
2.7 Right Lower Lobe
2.8 Left Upper Lobe
2.9 Left Lower Lobe
References
3: Bronchoscopic Anatomy
3.1 Introduction
3.2 Tracheal Anatomy
3.3 Right Bronchial Tree Anatomy
3.4 Left Bronchial Tree Anatomy
3.5 Segmental Anomalies of the Tracheobronchial Tree
References
4: Intersegmental Plane: Selective Inflation or Clamp of Target Segment
4.1 Introduction
4.2 Techniques
4.2.1 Inflation–Deflation Method
4.2.1.1 Introduction
4.2.1.2 Operative Steps
4.2.1.3 Specific Technique Considerations
4.2.2 Selective Deflation: Slip-Knot Technique
4.2.2.1 Introduction
4.2.2.2 Operative Steps
4.2.2.3 Specific Technique Considerations
4.2.3 Selective Inflation: Jet Flow
4.2.3.1 Introduction
4.2.3.2 Operative Steps
4.2.3.3 Specific Technique Considerations
4.2.4 Selective Inflation: Catheter or Needle
4.2.4.1 Introduction
4.2.4.2 Operative Steps
4.2.4.3 Specific Technique Considerations
4.3 Conclusions
4.4 Summary Video
References
5: Intersegmental Plane: Indocyanine Green
5.1 Preoperative Evaluation
5.2 Operative Steps
5.2.1 Exposure and Division of the Segmental Arteries
5.2.2 Exposure and Division of the Segmental Bronchus
5.2.3 Dissection of the Hilum
5.2.4 Systemic Injection of Indocyanine Green and Confirmation of the Intersegmental Border
5.2.5 Division of the Lung Parenchyma
5.2.6 Hilar Lymph Node Dissection
5.3 Video Summary (Video 5.4)
References
6: Intersegmental Plane: Virtual-Assisted Lung Mapping (VAL-MAP)
6.1 General Introduction of VAL-MAP
6.1.1 Principles and Indications of VAL-MAP (Video 6.1)
6.1.2 Roles of VAL-MAP in Segmentectomy (Video 6.2)
6.1.3 Variations of VAL-MAP (Video 6.3)
6.2 Steps of the VAL-MAP Procedure
6.2.1 Planning for Surgery and Lung-Map Design (Video 6.4)
6.2.2 Virtual Bronchoscopy (Video 6.5)
6.2.3 Bronchoscopic Mapping Procedure (Video 6.6)
6.2.4 Post-Mapping CT and 3D Reconstruction (Video 6.8)
6.3 Steps of Sublobar Lung Resection Assisted by VAL-MAP
6.3.1 Segmentectomies Assisted by VAL-MAP (Video 6.9)
6.3.2 Extended Segmentectomy (Video 6.10)
6.3.3 Combined Subsegmentectomy (Video 6.11)
6.3.4 VAL-MAP 2.0: Adjustment of the Resection Lines Under Fluoroscopic View (Video 6.12)
References
7: Lymphadenectomy During Sublobar Resections
7.1 Introduction
7.2 Right lymphadenectomy: Operative Steps
7.3 Left Lymphadenectomy: Operative Steps
References
Part II: Right Lung Sublobar Resections
8: Right Apical Segmentectomy (S1)
8.1 Anatomical Landmarks
8.2 Operative Steps
8.2.1 Dissection and Division of the Apical Segmental Artery (A1) (Video 8.1)
8.2.2 Dissection and Division of the Apical Segmental Bronchus (B1) (Video 8.2)
8.2.3 Dissection and Division of the Apical Segmental Vein (V1) (Video 8.3)
8.2.4 Identification and Division of the Intersegmental Plane (Video 8.4)
8.3 Summary Video
References
9: Right Posterior Segmentectomy (S2)
9.1 Anatomical Landmarks
9.2 Operative Steps
9.2.1 Major Fissure Opening
9.2.2 Ascending A2 Control and Section
9.2.3 Exposure of the Central Vein and Its Branches
9.2.4 Control and Section of V2a + b and V2c
9.2.5 B2 Control and Section
9.2.6 Identification, Control and Section of A2rec
9.2.7 Identification and Section of the Intersegmental Plane
9.2.8 Removal of Segment 2
9.2.9 Intersegmental, Hilar, and Mediastinal Lymphadenectomy
9.2.10 Closure
9.3 Summary Video
References
10: Right Anterior Segmentectomy (S3)
10.1 Anatomical Landmarks
10.2 Operative Steps
10.2.1 Exposure of the Hilar Structures: Central Vein and Branches, Main Pulmonary Artery, Truncus Superior and Intermedius
10.2.2 Minor Fissure Assessment
10.2.3 Control and Section of V3a + b + c
10.2.4 Control and Section of A3
10.2.5 Control and Section of B3
10.2.6 Identification and Section of the Intersegmental Plane
10.2.7 Removal of S3
10.2.8 Lymphadenectomy
10.2.9 Closure
10.3 Summary Video
References
11: Right Upper Segmentectomy (S6)
11.1 Anatomical Landmarks
11.2 Operative Steps
11.2.1 Exposure of the Inferior Pulmonary Vein. Dissection and Division of V6
11.2.2 Division of the Major Fissure and Access to the Pulmonary Artery in the Fissure
11.2.3 Exposure and Section of A6
11.2.4 Peribronchial and Lymphatic Dissection. Bronchial Section
11.2.5 Identification and Section of the Intersegmental Plane
11.3 Summary Video
References
12: Right Common Basal Segmentectomy (S7 + S8 + S9 + S10)
12.1 Anatomical Landmarks
12.2 Operative Steps During Unidirectional Approach
12.2.1 Dissection of Anterior Oblique Fissure
12.2.2 Identification of the Basilar Artery and A6
12.2.3 Identification of Basilar Bronchus and B6
12.2.4 Identification of Basilar Vein and V6
12.2.5 Intersegmental Plane Between Basilar Segment and S6 Division
12.2.6 Specimen Removal and Closure
12.3 Summary Video
12.4 Operative Steps During Bidirectional Approach
12.4.1 Dissection of Anterior Oblique Fissure
12.4.2 Identification of the Basilar Artery and A6
12.4.3 Identification of Basilar Vein and V6
12.4.4 Division of Vessels
12.4.5 Intersegmental Plane Between Basilar Segment and S6 Division
12.4.6 Basilar Bronchus Division
12.4.7 Specimen Removal and Closure
12.5 Summary Video
12.6 Permission
References
13: Right Anteromedial Basal Bisegmentectomy (S7 + S8)
13.1 Anatomical Landmarks
13.2 Operative Steps
13.2.1 Pulmonary Nodule Identification
13.2.2 Division of Inferior Pulmonary Ligament
13.2.3 Dissecting Oblique Fissure and Exposing Pulmonary Artery
13.2.4 Division of Right Anteromedial Pulmonary Artery Branch (A7 + 8) (Video 13.1)
13.2.5 Division of Right Anteromedial Pulmonary Vein Branch (V7 + 8) (Video 13.2)
13.2.6 Division of Right Anteromedial Bronchus Branch (B7 + 8) (Video 13.3)
13.2.7 Identifying and Division of the Intersegmental Plane (Videos 13.4, 13.5, and 13.6)
13.3 Summary Video
References
14: Right Lateroposterior Basal Bisegmentectomy (S9 + S10)
14.1 Anatomical Landmarks
14.2 Operative Steps
14.2.1 Opening Major Fissure
14.2.2 Exposure and Control of Arterial Segmental Branches. Division
14.2.3 Exposure and Control of Venous Segmental Branches. Division
14.2.4 Completion of the Intersegmental Plane Between S9 + S10 and S6
14.2.5 Bronchial Exposure and Division of B9 and B10
14.2.6 Completion of the Intersegmental Plane Between S9 + S10 and S7 + S8
14.2.7 Specimen Removal and Closure
14.3 Summary Video
References
Part III: Left Lung Sublobar Resections
15: Left Apicoposterior Bisegmentectomy (S1 + S2)
15.1 Anatomical Landmarks
15.2 Operative Steps
15.2.1 Anterior Hilar Dissection
15.2.2 Posterior Hilar Dissection
15.2.3 Fissure Dissection
15.2.4 Bronchovascular Segmental Ligation and Division
15.2.5 Intersegmental Parenchymal Division
References
16: Left Anterior Segmentectomy (S3)
16.1 Anatomical Landmarks [1–9]
16.2 Operative Steps
16.2.1 Control and Section of V3
16.2.2 Dissection and Division of B3
16.2.3 Division of A3
16.2.4 Identification and Division of the Intersegmental Plane
16.2.5 Closure
16.3 Summary Video
References
17: Left Upper Trisegmentectomy (S1 + S2 + S3)
17.1 Anatomical Landmarks
17.2 Operative Steps
17.2.1 Identification, Control and Section of V1–V3 (Video 17.1)
17.2.2 Identification, Control and Section of A1 + 2 + A3 Arteries (Video 17.2)
17.2.3 Identification, Control and Section of Rest of Arteries
17.2.4 Exposure of the LUL Bronchus and its Division B1–3 and B4–5. Section of B1–B3
17.2.5 Preparation of the Intersegmental Plane
17.2.6 Identification and Section of the Intersegmental Plane
17.2.7 Lymphadenectomy
17.3 Summary Video
References
18: Lingulectomy (S4 + S5)
18.1 Anatomical Landmarks
18.2 Operative Steps
18.2.1 Dissection of the Fissure to Identify the Interlobar Pulmonary Artery
18.2.2 Dissection and Section of the Lingular Artery (A4 + 5)
18.2.3 Dissection and Section of the Lingular Vein (V4 + 5)
18.2.4 Dissection and Division of Lingular Bronchus
18.2.5 Division of Intersegmental Plane
18.3 Summary Video
References
19: Left Upper Segmentectomy (S6)
19.1 Anatomical Landmarks
19.2 Operative Steps
19.2.1 Opening of the Major Fissure and Dissection and Section of the Segmental Artery (A6)
19.2.2 Exposure and Section of the Segmental Bronchus B6
19.2.3 Venous Dissection and Section (V6 and Identification of V6a)
19.2.4 Preparation of the Intersegmental Plane
19.2.5 Specimen Removal
19.2.6 Lymphadenectomy
19.2.7 Closure and Security Check
19.3 Summary Video
References
20: Left Common Basal Segmentectomy (S8 + S9 + S10)
20.1 Anatomical Landmarks
20.2 Operative Steps
20.2.1 Division of Inferior Pulmonary Ligament
20.2.2 Dissection of Pulmonary Vein
20.2.3 Identification of Lower Lobe Pulmonary Arterial (PA) Anatomy
20.2.4 Division of Basilar Pulmonary Artery
20.2.5 Division of Basilar Pulmonary Vein
20.2.6 Inferior Dissection of Basilar Bronchus
20.2.7 Completion of Anterior Fissure
20.2.8 Anterior Dissection of Basilar Bronchus
20.2.9 Division of Bronchus
20.2.10 Division of Segmental Parenchyma
20.2.11 Removal of Specimen
20.2.12 Lymphadenectomy
20.3 Summary Video
Reference
21: Left Anterior Basal Segmentectomy (S8)
21.1 Anatomical Landmarks
21.2 Operative Steps
21.2.1 Segmental Artery Dissection and Division
21.2.2 Segmental Bronchus Dissection
21.2.3 Segmental Bronchus Division
21.2.4 Segmental Vein Dissection and Division
21.2.5 Posterior Intersegmental Plane Division
21.2.6 Segmental Lymphadenectomy
21.2.7 Intersegmental Plane Division with S9
21.2.8 Specimen Removal and Lymph Node Dissection
References
22: Left Lateroposterior Basal Bisegmentectomy (S9 + S10)
22.1 Anatomical Landmarks
22.2 Operative Steps
22.2.1 Segmental Artery Dissection and Division
22.2.2 Segmental Bronchus Dissection
22.2.3 Segmental Vein Dissection and Division
22.2.4 Posterior Intersegmental Plane Division
22.2.5 Segmental Bronchus Division
22.2.6 Segmental Lymphadenectomy
22.2.7 Anterior Intersegmental Plane Division
22.2.8 Specimen Removal and Lymph Node Dissection
References
Part IV: Special Combinations of Sublobar Resections
23: Right S1 + S2 Bisegmentectomy
23.1 Anatomical Landmarks
23.2 Operative Steps
23.2.1 Division of Posterior Major Fissure
23.2.2 Apical Segmental Srtery A1
23.2.3 PosteriorAascending Segmental Artery A2b
23.2.4 Apical Segmental Vein V1
23.2.5 Posterior Segmental Vein V2
23.2.6 Apical Segmental Bronchus B1 and Posterior Segmental Bronchus B2
23.2.7 Identification of Segmental Plane
23.2.8 Specimen Removal
23.2.9 Closure
23.3 Summary Video
24: Right S1 + S3 Bisegmentectomy
24.1 Anatomical Landmarks
24.2 Operative Steps
24.2.1 Pulmonary Nodule Identification (Video 24.1)
24.2.2 Vein (V1, V3b, V3a) and Minor Fissure Division (Video 24.2)
24.2.3 Minor Fissure Division
24.2.4 Artery (A1, A3) (Video 24.5)
24.2.5 Bronchi (B1, B3) (Video 24.6)
24.2.6 Intersegmental Plane Division (Video 24.7)
24.3 Summary Video
References
25: Right S2 + S6 Bisegmentectomy
25.1 Anatomical Landmarks [1, 2]
25.2 Operative Steps
25.2.1 Pulmonary Nodule Identification
25.2.2 Dissection of Posterior Mediastinal Pleura
25.2.3 Hilar Dissection of S6
25.2.4 Hilar Dissection of S2
25.2.5 Individual Dissection of Intersegmental Planes of S6 and S2
25.3 Summary Video
References
26: S6 + S10 Bisegmentectomy
26.1 Anatomical Landmarks
26.2 Operative Steps
26.2.1 Interlobar Artery Exposure and Major Fissure Opening
26.2.2 A6 + B6 Control and Section
26.2.3 A10 and V6 + V10 Control and Section
26.2.4 B10 Control and Section
26.2.5 Division of the Pulmonary Ligament and the Intersegmental Plane
26.2.6 Removal of Segment 6+10
26.2.7 Lymphadenectomy
26.2.8 Closure
26.3 Summary Video
References
27: Left S8 + S9 Bisegmentectomy
27.1 Anatomical Landmarks
27.2 Operative Steps
27.2.1 Fissure Opening
27.2.2 A8 and A9 Dissection and Section
27.2.3 Identification and Division of B8 and B9 and Intersegmental Plane Delimitation
27.2.4 V8 and V9 Dissection and Division
27.2.5 Intersegmental Plane Division
27.2.6 Lymph Nodes Assessment
27.2.7 Closure
References