Yasuji Terada, S. Ota, F. Gochi, T. Kono, T. Yoshimura, Y. Matsubara
2015 Interactive Cardiovascular and Thoracic Surgery  
Objectives: The pulmonary segmental plane running between two adjacent pulmonary segments consists of a very thin layer of connective tissue through which the pulmonary vein also runs. To perform anatomically correct segmentectomy, the segmental plane needs to be divided. Our operative technique for anatomical segmentectomy involves dividing the segmental plane from the hilum to the periphery. Video description: Before the operation, the locations of vessels and bronchi are confirmed by
more » ... onfirmed by three-dimensional CT. A 4-cm mini-thoracotomy skin incision is made in the 4th or 5th intercostal space on the antero-axillary line. After complete exposure of the pulmonary artery and bronchus, the pulmonary arteries of the target segment are ligated and resected to reduce bleeding from the divided segmental plane. The segmental plane can be confirmed by dissection of the lung parenchyma from the point of divergence of the segmental bronchi to the visceral pleura using a dull-tipped forceps or suction tube. The dissection is performed bluntly with confirmation of the pulmonary vein, and the visceral pleura is divided using electrocautery. The pulmonary veins are retained on the side of the segment in which blood mainly flows out, and the thick branch crossing the plane is cut using an energy device. Bleeding from fine branches of pulmonary veins with low blood pressure can be reduced by pulling the lung upward, and haemostasis can be completed by vessel contraction and coagulation. Electrocautery is used for dividing the visceral pleura, and a stapler is used only for the pulmonary vein and bronchus. Major air leaks are closed by suturing, whereas minor leaks can be covered with coagulated blood and do not require closure. Conclusions: Anatomical segmentectomy with correct division of the segmental plane does not require haemostasis or closure of air leaks, and no fibrin glue or biomaterial sheets may be necessary. Disclosure: No significant relationships. Interactive CardioVascular and Thoracic Surgery
doi:10.1093/icvts/ivv204.157 fatcat:gjxk6ugdijcexgrvvz32vgbyte