Modified inflation-deflation for 146 thoracscopic cone-shaped segmentectomies

Objective This study applied"modified inflation-deflation"to identify the intersegmental plane and explored a method to remove pulmonary segments from the lobe on the basis of cone-shaped principle."Cone-shaped"Segmentectomy includes anatomical separation of the hilum(conical tip) and the intersegmental plane(undissociative conical surface). The feasibility was evaluated. Methods We retrospectively reviewed 146 patients with peripheric pulmonary nodules who underwent cone-shaped segmentectomy between September 2013 and August 2016. Under the guidance of preoperative 3D-CTBA(three-dimensional computed tomography bronchography and angiography)the targeted bronchi and arteries were dissected. The intersegmental plane was identified by"modified inflation-deflation"method. The inflation-deflation interface was anatomically separated from hilum to distal region along the intersegmental veins, while leaving 1-2 cm in thickness from far end. The residual intersegmental parenchyma was then dissected using endo staplers. Mean follow-up was 20.4 months. Results Sixty two single segmentectomies, 38 combined segmentectomies, 43 subsegmentectomies and 3 subsubsegmentectomies were performed. Twelve diagnoses of benign nodule, 15 diagnoses of atypical adenomatous hyperplasia, 6 diagnoses of metastatic carcinoma and 113 diagnosis of primary pulmonary cancer were confirmed pathologically."Modified inflation-deflation"spent(12.5±6.4)minutes to show the clear inflation-deflation line. All the targeted bronchi and arteries were dissected precisely and the intersegmental veins were preserved. All the preserved adjacent segments kept approximately original shape after inflated. The tumor size was(1.4±0.7)cm, the surgical margin width was(2.5±1.6)cm. The depth of the separated intersegmental plane was(4.2±1.7)cm, and the width of the plane was(6.5±2.2)cm. The operative time was(158.5±42.6)min, the volume of hemorrhage was(25.2±15.7)ml, the postoperative hospital stay was(5.2±2.2)days. The total incidence of complications was 5.5%(8/146). No death within 30 days occurred. Among 113 primary pulmonary cancers, there were 35 T0N0M0(adenocarcinoma in situ) and 78 T1aN0M0 non-small-cell lung cancers. One patient had local recurrence, and no death occurred during follow-up period. Conclusion Modified inflation-deflation can show clear inflation-deflation line to identify the intersegmental plane. Thoracscopic cone-shaped segmentectomy can achieve a complete anatomical segmentectomy. Key words: Coin lesion, pulmonary; Inflation-deflation; Thoracoscopy; Pneumonectomy