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Supplement: The Minimally Invasive Thoracic Surgery Summit

Thoracoscopic Segmentectomy: Technical Considerations and Outcomes

Department of Surgery, Duke University Medical Center, Durham, North Carolina

^_* Address correspondence to Dr D’Amico, Duke University Medical Center, Box 3496, Durham, NC 27710 (Email: damic001@mc.duke.edu).

Presented at the Minimally Invasive Thoracic Surgery Summit, New York, NY, June 8–9, 2007.

The first 20% of the full text of this article appears below.

	Introduction

 
Minimally invasive strategies in the management of primary and secondary pulmonary malignancies are evolving. Thoracoscopic lobectomy is defined as the anatomic resection of an entire lobe of the lung, using a videoscope and an access incision, without the use of a mechanical retractor and without rib-spreading [1–5]. The anatomic resection includes individual dissection and stapling of the involved pulmonary vein, pulmonary artery, and bronchus, as well as appropriate management of the mediastinal lymph nodes, as would be performed with thoracotomy. Thoracoscopic segmentectomy refers to minimally invasive sublobar anatomic resection of single or multiple bronchopulmonary segments [6]. Potential advantages of the minimally invasive technique include decreased postoperative pain, faster return to full activity, shorter chest tube duration, shorter length of stay, preserved pulmonary function, fewer overall postoperative complications, and improved compliance with adjuvant chemotherapy compared with lobectomy done with open thoracotomy [1–6].

Lobectomy is considered the standard of care for operable patients with completely resectable clinical stage I non-small cell lung cancer [7]. Sublobar anatomic resection, or segmentectomy, has been proposed for selected patients with marginal pulmonary function and for patients with resectable central pulmonary metastases. The potential advantage of segmentectomy compared with lobectomy is preservation of pulmonary function; the potential advantage compared with wedge resection is improved oncologic outcome [7]. Reported experience with thoracoscopic segmentectomy is limited. This review describes the techniques used for thoracoscopic segmentectomy and the clinical results with this procedure.

	General Strategy for Thoracoscopic Segmentectomy

 
The standard segmentectomies performed with this technique include lingula-sparing left upper lobectomy, lingulectomy, superior segmentectomy, and basilar segmentectomy. Other individual segmental resections, such has posterior or anterior upper lobe segmentectomy, are feasible but less commonly performed.

The technique for thoracoscopic segmentectomy uses the fundamentals of thoracoscopic lobectomy . . . [Full Text of this Article]

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