Abdelsattar Zaid M, Blackmon Shanda H
Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
J Thorac Dis. 2018 Apr;10(Suppl 10):S1168-S1178. doi: 10.21037/jtd.2018.02.22.
There are many novel technologies that enable complex segmentectomy to be performed. As lung cancer screening becomes more prevalent, patients are increasingly diagnosed with early stage lung cancer, multifocal disease, and second primary tumors. This shift to an earlier clinical presentation combined with advances in technology and an emphasis on minimally invasive techniques have led to the current developments we are now seeing with anatomic segmentectomy. In this paper, we describe the operative technique of an indocyanine green (ICG)-guided video-assisted thoracoscopic surgery (VATS) single basilar segmental resection, augmented with methylene blue dye marker localization via SuperDimension electromagnetic navigational bronchoscopy. The CT scans of the posterior basal segment tumor are enhanced with three-dimensional (3D) modeling. A description of the approach is detailed with a video, intraoperative photographs, and illustrations. Successful removal of the S segment with novel techniques permitted the patient to have five percent of the lung removed (segmentectomy) instead of 25% (right lower lobectomy). In the setting of multifocal disease, future treatment options for the tumors in other locations of the lung are enhanced. Novel lung imaging techniques along with careful intraoperative identification of appropriate segmental anatomy allow patients to be offered an optimal basilar parenchymal-sparing segmentectomy.
有许多新技术可用于实施复杂的肺段切除术。随着肺癌筛查日益普遍,越来越多的患者被诊断为早期肺癌、多灶性疾病和第二原发性肿瘤。这种向更早期临床表现的转变,再加上技术的进步以及对微创技术的重视,促成了我们目前在解剖性肺段切除术中所看到的发展。在本文中,我们描述了一种吲哚菁绿(ICG)引导的电视辅助胸腔镜手术(VATS)单基底段切除术的手术技术,并通过超维度电磁导航支气管镜辅助亚甲蓝染料标记定位。通过三维(3D)建模增强后基底段肿瘤的CT扫描。通过视频、术中照片和插图详细描述了手术方法。采用新技术成功切除S段,使患者仅切除5%的肺组织(肺段切除术),而非25%(右下叶切除术)。在多灶性疾病的情况下,肺部其他部位肿瘤的未来治疗选择也得到了改善。新颖的肺部成像技术以及术中对合适肺段解剖结构的仔细识别,使患者能够接受最佳的保留基底实质的肺段切除术。