An optimal thoracoscopic segmentectomy approach: Combined ultra‐high‐definition 4K endovision systems with “no‐waiting” technique in S8‐9 complex segmentectomy

• Published in: Thoracic cancer 2023-04, Vol.14 (12), p.1098-1101
• Main Authors: Liang, Mingqiang, Wang, Liang, Gao, Jiabin, Duan, Zhiliang, Xu, Jinhai, Wang, Yifang, Li, Shixin, Wang, Bowen, Chen, Chun
• Format: Article
• Language: English
• Subjects: 4K endovision systems; Aged; Case Report; Case reports; Cholecystectomy; Conflicts of interest; Consent; Endoscopy; Female; Humans; Lung - surgery; Lung cancer; Lung Neoplasms - surgery; Pneumonectomy - methods; Pulmonary arteries; pulmonary nodules; segmentectomy; Thoracic surgery; Thoracoscopy - methods; Tomography; Veins & arteries; “no‐waiting” technique
• ISSN: 1759-7706; 1759-7714
• DOI: 10.1111/1759-7714.14833

Thoracoscopic segmentectomy might be an alternative to lobectomy for small size lung cancer. Precise identification of the pulmonary intersegmental plane was needed for an optimal segmentectomy. Recently, (1) the ultra‐high‐definition 4K systems had claimed to overcome the lack of depth perception by secondary visual cues; (2) the no‐waiting procedure was induced as an alternative and optimized method for identifying the plane. It was unclear whether combined ultra‐high‐definition 4K endovision systems with “no‐waiting” technique in thoracoscopic segmentectomy could achieve an excellent result. A 68‐year‐old female patient was admitted into our hospital for occasional pulmonary nodule during her routine physical examination. The nodule is located between S8 and S9 segment, and was suspected to be an early‐stage lung cancer. She underwent a thoracoscopic S89 complex segmentectomy using ultra‐high‐definition 4K endovision systems and “no‐waiting” surgical technique. The intersegmental plane was clearly detected and easily treated by the endoscopic linear cutting staplers. The patient recovered well and was discharged without complications. Combining ultra‐high‐definition 4K endovision systems with “no‐waiting” technique seems to be an optimal thoracoscopic segmentectomy approach for the management of lung cancers. In segmentectomy, the conventional method is to deal with the pulmonary artery, bronchus and pulmonary vein, then determine the intersegmental plane using “inflation–deinflation” method, and cut the plane finally. This “inflation–deinflation” method usually takes 15 minutes, or even longer. The “no waiting” method optimizes the flow of the above steps. After the pulmonary artery was processed, the intersegmental plane procedure was directly executed. During the time of the collapse of lung tissue, the bronchus and pulmonary vein were processed successively. Finally, the intersegmental plane was cut. In this process, we can save a lot of operation time. A high‐resolution 4K thoracoscope is more useful for this technique.