Anatomical Landmarks for Anatomical Segmentectomies

This video addresses a segmental anatomy operation, which is a key point in segmentectomies performed via video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS).

In this case, the anatomical variations of the segmental bronchovascular pedicles were highly variable. Cases of limited vision are often present in the fields of video-assisted and robotics surgery; this case was no exception. As a result, the operation was conducted with the anticipation of bronchovascular pedicle variations. The preoperative study of the anatomy was conducted via 3D modeling or 3D printing, or even by a mixed-reality system. Advanced anatomical studies are a nearly mandatory step in the practice of segmentectomies.

Procedure

The case shown in the video above successively treated the nomenclature of segments and the anatomy of the right upper, middle, left upper, and two lower lobes. In this procedure, the two lower lobes were studied together. The procedure was based on 3D models and intraoperative views derived from 850 thoracoscopic anatomical segmentectomies. The case’s base data was borrowed from the Illustrated Anatomical Segmentectomy for Lung Cancer atlas by Hiroaki Nomori and Morihito Okada.

References

1. Nomori, H. and M. Okada. Illustrated anatomical Segmentectomy for Lung Cancer. Tokyo, Springer-Verlag 2012.
2. Gossot, D. Atlas of endoscopic major pulmonary resections – 3rd edition, Springer-Verlag 2021.
3. Seguin-Givelet A, Grigoroiu M, Brian E, Gossot D. Planning and marking for thoracoscopic anatomical segmentectomies. J Thorac Dis. 2018;10(Suppl 10):S1187-S1194
4. Gossot D, Mariolo AV, Grigoroiu M, Bardet J, Boddaert G, Brian E, Seguin-Givelet A. Thoracoscopic complex basilar segmentectomies: an analysis of 63 procedures. J Thorac Dis. 2021;13:4378-4387
5. Sekine Y, Itoh T, Toyoda T, Kaiho T, Koh E, Kamata T, Hoshino H, Hata A. Precise Anatomical Sublobar Resection Using a 3D Medical Image Analyzer and Fluorescence-Guided Surgery With Transbronchial Instillation of Indocyanine Green. Semin Thorac Cardiovasc Surg. 2019;31:595-60
6. Gossot D, Lutz JA, Grigoroiu M, Brian E, Seguin-Givelet A. Unplanned Procedures During Thoracoscopic Segmentectomies. Ann Thorac Surg. 2017;104:1710-1717

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