Video-assisted thoracic surgery (VATS) segmentectomy: state of the art.

The role of video-assisted thoracic surgery (VATS) in the treatment of lung cancer is well established. However a topic of current debate centers on the role of parenchymal-sparing operations, segmentectomy in particular, in the treatment of non-small cell lung cancer (NSCLC). Current reports in the literature draw dramatically different conclusions regarding the efficacy and safety of segmentectomy versus lobectomy for NSCLC. Two randomized controlled trials are currently underway to shed further light on this topic. Lobectomy remains the standard of care, with VATS approaches demonstrating improved morbidity. Experience in literature suggests segmentectomy is a viable approach for patients with limited cardiopulmonary reserve, or who would otherwise be unable to tolerate lobectomy. Thus, VATS segmentectomy is a vital skill in the armamentarium of today's thoracic surgeon. Minimally invasive approaches to segmentectomy are accomplished with a certain amount of finesse and a thorough understanding of the associated anatomy. A technical description of VATS segmentectomy is provided.