Sato Masaaki, Murayama Tomonori, Nakajima Jun
Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
J Thorac Dis. 2016 Oct;8(Suppl 9):S716-S730. doi: 10.21037/jtd.2016.09.56.
Anatomical segmentectomies play an important role in oncological lung resection, particularly for ground-glass types of primary lung cancers. This operation can also be applied to metastatic lung tumors deep in the lung. Virtual assisted lung mapping (VAL-MAP) is a novel technique that allows for bronchoscopic multi-spot dye markings to provide "geometric information" to the lung surface, using three-dimensional virtual images. In addition to wedge resections, VAL-MAP has been found to be useful in thoracoscopic segmentectomies, particularly complex segmentectomies, such as combined subsegmentectomies or extended segmentectomies. There are five steps in VAL-MAP-assisted segmentectomies: (I) "standing" stitches along the resection lines; (II) cleaning hilar anatomy; (III) confirming hilar anatomy; (IV) going 1 cm deeper; (V) step-by-step stapling technique. Depending on the anatomy, segmentectomies can be classified into linear (lingular, S6, S2), V- or U-shaped (right S1, left S3, S2b + S3a), and three dimensional (S7, S8, S9, S10) segmentectomies. Particularly three dimensional segmentectomies are challenging in the complexity of stapling techniques. This review focuses on how VAL-MAP can be utilized in segmentectomy, and how this technique can assist the stapling process in even the most challenging ones.
解剖性肺段切除术在肺癌肿瘤切除中发挥着重要作用，特别是对于磨玻璃型原发性肺癌。该手术也可应用于肺深部的转移性肺肿瘤。虚拟辅助肺标测（VAL-MAP）是一种新技术，它利用三维虚拟图像，通过支气管镜多点染料标记为肺表面提供“几何信息”。除楔形切除术外，VAL-MAP已被发现可用于胸腔镜肺段切除术，特别是复杂的肺段切除术，如联合亚段切除术或扩大肺段切除术。VAL-MAP辅助肺段切除术有五个步骤：（I）沿切除线“站立”缝合；（II）清理肺门解剖结构；（III）确认肺门解剖结构；（IV）再深入1厘米；（V）逐步缝合技术。根据解剖结构，肺段切除术可分为线性（舌段、S6、S2）、V形或U形（右S1、左S3、S2b+S3a）和三维（S7、S8、S9、S10）肺段切除术。特别是三维肺段切除术在缝合技术的复杂性方面具有挑战性。本综述重点关注VAL-MAP如何应用于肺段切除术，以及该技术如何在最具挑战性的手术中协助缝合过程。
