Ken Fukaya

Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: A report of 52 consecutive cases

OBJECTIVE The purpose of this retrospective study was to evaluate the efficacy of anatomic thoracoscopic pulmonary segmentectomy performed under the guidance of 3-dimensional multidetector computed tomography simulation. METHODS Between September 2004 and June 2009, 52 patients (median age, 68 years; range, 16-85 years) underwent thoracoscopic segmentectomy without mini-thoracotomy. Images were obtained by using 64-channel multidetector computed tomography and a contrast agent. The pulmonary arteriovenous structure was mainly determined using a 3-dimensional volume-rendering method. The preoperative simulation was performed at the initial stage of the study and the intraoperative at a later stage. The simulated images were used to identify the venous branches in the affected segment for division and the intersegmental veins to be preserved. Four 5- to 20-mm ports were used. Segmentectomy was performed by separating the pulmonary arteries and bronchi followed by dissection along the intersegmental plane. RESULTS Fifty-one patients underwent a complete thoracoscopic segmentectomy. A mini-thoracotomy was performed in 1 case because of arterial bleeding. The success rate of segmentectomies under complete thoracoscopy was 98%. The procedure was classified into 3 categories according to the degree of surgical difficulty. Before introducing the simulation, there were 4 easy cases and 1 fairly difficult case. After introducing preoperative simulation, 7 cases were classified as fairly difficult among 12 segmentectomy cases. Furthermore, 7 cases of difficult segmentectomy were performed using intraoperative simulation. No local recurrence or metastasis and no mortality were observed during the follow-up. CONCLUSIONS Thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation is a safe technique.

Role of diffusion-weighted magnetic resonance imaging for predicting of tumor invasiveness for clinical stage IA non-small cell lung cancer

OBJECTIVES Recently, diffusion-weighted MR imaging (DWI) for the whole body has become available for clinical use, as has been previously used for the central nervous system. Favorable results have been reported using this imaging system to differentiate between benign and malignant lesions in some organs, and to correlate with the degree of cell differentiation in lung cancer. The purpose of this study was to assess the role of DWI for predicting tumor invasiveness of non-small cell lung cancers (NSCLC), especially for clinical stage IA patients. METHODS From January 2006 to September 2007, preoperative DWI and 18F-FDG-PET/CT were performed on 41 patients with clinical stage IA NSCLC who had undergone curative operations. Lung cancers that exhibited nodal, lymphovascular or pleural invasion were defined as invasive lung cancers. Nodules with strong dark signal, as observed by DWI in spinal cords, were defined as DWI-positive. We analyzed the associations between the pathological findings and the following preoperative clinical factors: age, gender, smoking history, preoperative CEA levels (<5.0 or >/=5.0ng/ml), preoperative tumor size, SUV max on PET/CT (<5.0 or >/=5.0) and DWI (positive or negative). RESULTS A total of 15 lesions (37%) were assessed as DWI-positive and 26 lesions (63%) were DWI-negative. Univariate analyses showed positive correlations for development of invasive cancer with the preoperative CEA level (p=0.049), SUV max (p=0.001) and DWI (p<0.001). Multivariate analysis showed that DWI (p=0.005) was an independent predictive factor for tumor invasiveness. CONCLUSION Our results suggest that DWI might be a useful method for predicting tumor invasiveness for clinical stage IA NSCLC.

Total thoracoscopic pulmonary segmentectomy

OBJECTIVE In lung resection, thoracoscopy has been mainly used for wedge resection and lobectomy. There have been very few reports on pulmonary segmentectomy, mainly because of its complex nature. The present report evaluates the safety and efficacy of thoracoscopic pulmonary segmentectomy for the treatment of benign lung diseases or small lung carcinomas. METHODS The study involved 30 patients who underwent thoracoscopic segmentectomy without a minithoracotomy from September 2004 to March 2008. The median age of the patients was 69 years (range, 16-81 years). Four 5-20 mm ports were used. The pulmonary vessels were ligated, and the bronchi were closed using a stapler. An electrocautery was used for intersegmental dissection. Chest tubes were inserted in all cases. RESULTS Twenty-eight patients underwent complete thoracoscopic segmentectomy. A minithoracotomy was created in one case because of arterial bleeding, and open lobectomy was performed in another case owing to the diagnosis of small cell carcinoma. The operative time ranged from 147 to 425 min (median time, 216 min). The inserted chest tubes were maintained in position for 1-7 days (median duration, 1 day). One patient developed subcutaneous emphysema that spontaneously resolved. No mortality was observed for 30 days after the surgery. Further, no local recurrence or metastases were observed during follow-up in cases of malignancy. CONCLUSIONS Thoracoscopic pulmonary segmentectomy is a feasible and safe technique. Reduced postoperative pain and an improved cosmetic outcome are considered advantages of this minimally invasive procedure.

Anatomical Lung Segmentectomy Simulated by Computed Tomographic Angiography

We describe the benefits of simulating lung segmentectomy by using multi-detector computed tomographic angiography. Preoperative determination of the anatomical, intersegmental plane is possible by visualizing the branches of the pulmonary veins. This new technique could be useful in thoracoscopic segmentectomy of the lung.

A technique for retrieving a lung lobe in a bag from a small wound during thoracoscopic surgery

We herein describe our technique for removing lung specimens during thoracoscopic resection. This technique allows extraction of intact lung specimens through a small incision. We believe that it is feasible, can be easily and rapidly performed, and facilitates thoracoscopic lung resection by reducing the technical difficulties involved in specimen removal; we also think that it may be used in other thoracoscopic interventions.