A novel video-assisted anatomic segmentectomy technique: Selective segmental inflation via bronchofiberoptic jet followed by cautery cutting

Objective: Segmentectomy is an anatomic parenchyma-sparing resection that is recently being performed for small-sized lung carcinoma and constitutes a useful procedure in a thoracic surgeon's armamentarium. We have generated a new technique that improves the identification of the intersegmental border and whose clinical utility we evaluate in this study. Methods: Under bronchofiberscopy, jet ventilation is selectively applied to the burdened bronchus to develop an anatomic plane between the inflated segment to be resected and the deflated area to be preserved. From April 2004 to June 2006, 52 consecutive patients with a clinical T1 N0 M0 peripheral cancer 2 cm or smaller underwent video-assisted segmental resection called hybrid VATS segmentectomy in which electrocautery with no stapler was used to divide the intersegmental plane detected by selective jet ventilation. Results: Complete resection was achieved in all patients. The median operative time and bleeding during the operation were 155 minutes (range 85-225 minutes) and 60 mL (range 10-210 mL), respectively. The complication rate was 13.5% (7/52), and the most common was concerning air leak. The median duration of postoperative air leak and chest tube drainage was 1 day and 3 days, respectively. There were no in-hospital deaths. There was one case of mediastinal lymph node recurrence and another of metastasis to the brain although there was no case of local recurrence in the surgical margin area. Conclusions: A novel video-assisted segmentectomy technique for lung cancer is clinically useful. Selective segmental inflation provides an obvious intersegmental plane quickly and easily, allowing a real margin distance in the ventilated segment. Despite the minimally invasive approach, since only the segment to be resected and not the entire lobe is expanded, an appropriate surgical view is possible.