Xin-Feng Xu

Thoracoscopic Right Posterior Segmentectomy of a Patient With Anomalous Bronchus and Pulmonary Vein

A 39-year-old woman was admitted to our hospital for a pure ground-glass opacity that had been detected in the right lung during a regular examination. A computed tomography scan showed a pure ground-glass opacity beneath the pleura of the right upper lobe of the lung that had enlarged over time. As a consequence, a lung adenocarcinoma was suspected. Meanwhile, three-dimensional computed tomography scans revealed a tracheal bronchus originating directly from the lateral wall of the trachea. The patient consequently underwent posterior segmental resection and mediastinal lymph node sampling by video-assisted thoracic surgery. During surgery, in addition to the tracheal bronchus, a variable central vein was found entering the left atrium dorsal to the right pulmonary artery trunk. We submit that, to the best of our knowledge, this is the first case of its kind ever reported.

Modified method for distinguishing the intersegmental border for lung segmentectomy

This paper analyzed the results of a modified and simpler technique for distinguishing the intersegmental border during lung segmentectomy surgery. From January 2013 to December 2015, 539 patients with screening‐detected lung nodules <2 cm in maximum diameter underwent anatomic segmentectomy. With the guidance of preoperative three‐dimensional computed tomography bronchography and angiography, the bronchus, artery, and intrasegmental vein of the targeted segment could be precisely dissected under unilateral differential ventilation, and then intersegmental demarcation was confirmed by the modified inflation‐deflation method. The demarcation presented by this method was highly coincident with the real intersegmental border. Dissection along the border between the collapsed and inflated segments using either electrocautery or staples was safe, with almost no air leak or bleeding. This technique is a simple and effective alternative to previously described intersegmental border marking methods.

Technique for tailoring complex demarcation in lung segmentectomy: Lung segmentectomy tailoring technique

Segmentectomy is a widely adopted surgical procedure, however, experiences of tailoring the intersegmental border have rarely been reported. This paper investigates the strategy and results of tailoring complex demarcation during lung segmentectomy surgery. Because intersegmental demarcation can be divided into plane or curved types according to the location and stereo shape of a segment, a one‐size‐fits‐all method for tailoring the intersegmental demarcation is obviously unreasonable. For tailoring a complex segmentectomy with two or more curved borders, tips including good exposure of the intersegmental demarcation, sharp‐blunt combined dissection skill, “work‐plane” extension, and “gate” opening techniques all contribute to an accurate segmentectomy. This technique, based on anatomical characteristics, can provide a cutting surface with a greater physiological shape and less curling of the edge, and should be recommended as a general standard method for tailoring complex demarcation.

Thoracoscopic pulmonary combined with Right S 1 a + S 2 a subsegmentectomy for deep intersegmental nodule surgery

The oncologic efficacy of pulmonary segmentectomy for early stage lung cancer has been long established. However, with the assistance of preoperative three-dimensional computed tomography bronchography and angiography (3D-CTBA), we found some nodules located at the intersegmental plane and in proximity to the intersegmental vein, which we designated as intersegmental nodules. For such nodules, an extended segmentectomy, bi-segmentectomy or lobectomy is usually performed to ensure a safe margin, as precautions should be taken to ensure no loss of lung function. Recently, our center innovatively developed a new method to resect such lesions by combining the subsegments around them. Here we report a case of combined subsegmentectomy of the right apical (S 1 a) and dorsal (S 2 a) subsegments for the treatment of early stage lung cancer.

Learning curve of totally thoracoscopic pulmonary segmentectomy

Totally thoracoscopic pulmonary segmentectomy (TTPS) is a feasible and safe technique that requires advanced thoracoscopic skills and knowledge of pulmonary anatomy. However, data describing the learning curve of TTPS have yet to be obtained. In this study, 128 patients who underwent TTPS between September 2010 and December 2013 were retrospectively analyzed to evaluate the learning curve and were divided chronologically into three phases, namely, ascending phase (A), plateau phase (B), and descending phase (C), through cumulative summation (CUSUM) for operative time (OT). Phases A, B, and C comprised 39, 33, and 56 cases, respectively. OT and blood loss decreased significantly from phases A to C (P < 0.01), and the frequency of intraoperative bronchoscopy for target bronchus identification decreased gradually (A, 8/39; B, 4/33; C, 3/56; P = 0.06). No significant differences were observed in demographic factors, conversion, complications, hospital stay, and retrieved lymph nodes among the three phases. Surgical outcomes and techniques improved with experience and volume. CUSUMOT indicated that the learning curve of TTPS should be more than 72 cases.

Thoracoscopic Pulmonary Sub-Subsegmentectomy Based on Three-Dimensional Images

Thoracoscopic anatomic pulmonary segmentectomy and subsegmentectomy have become sophisticated surgical solutions for complex pulmonary diseases. The rapid development of three-dimensional computed tomographic angiography (3DCTA) has made it possible to provide more refined individualized anatomic details and has consequently enabled subsubsegmentectomy (SSS). In this study, we report two successful thoracoscopic anatomic SSSs of the left S1+2aii and S3aii under the guidance of 3DCTA reconstructed images. To the best of our knowledge, these are the first two cases of SSSs ever detailed reported. The nomenclature of subsubsegments is adopted according to the Japanese Committee on the Nomenclature for Bronchial Branching.