title: Port-access thoracoscopic anatomical lung subsegmentectomy.
abstract: OBJECTIVE
  The diagnosis of small lung nodules has increased in recent years; limited resection and minimally invasive surgery are highly desirable in patients with these lesions. While wedge resection may be curative for small lung nodules, the technique is sometimes difficult to perform when the tumour nodule is near the pulmonary hilum. In such situations, either anatomical segmentectomy or subsegmentectomy can obtain an adequate surgical margin; port-access thoracoscopic surgery is the preferred type of minimally invasive surgery. Three-dimensional (3D) computed tomography (CT) simulations are reportedly useful in planning and performing thoracoscopic surgery. We use 3D CT simulation to aid thoracoscopic segmentectomy for small lung nodules and subsegmentectomy for even smaller nodules and conduct here a retrospective evaluation of the clinical results of subsegmentectomy. We present our technique for 3D CT simulation-assisted port-access thoracoscopic subsegmentectomy in the superior segment of the left lower lobe.
  
  
  METHODS
  Between July 2008 and June 2012, 15 patients underwent port-access thoracoscopic subsegmentectomy. We evaluated the pathological diagnoses, the tumour sizes, the indications, the operative times and the volumes of blood loss.
  
  
  RESULTS
  Seven patients were diagnosed with lung cancer (LC) and eight had metastatic lung tumours (MLT). The median tumour size was 12 mm. The indication for using this surgical technique was to secure surgical margins in 13 patients (LC, 6; MLT, 7) and because of poor surgical risk in two patients (LC, 1; MLT, 1). The mean surgical time was 166 min and the median blood loss was 19 ml. There were no recurrences.
  
  
  CONCLUSIONS
  Port-access thoracoscopic lung subsegmentectomy using 3D CT simulation can be safely performed and is able to secure adequate surgical margins.
authors: Second Department of Surgery, Yamagata University, Yamagata City, Japan. h-kato@med.id.yamagata-u.ac.jp
authors: Hirohisa
authors: H
authors: Kato
authors: Hiroyuki
authors: H
authors: Oizumi
authors: Takashi
authors: T
authors: Inoue
authors: Eiichi
authors: E
authors: Oba
authors: Ken
authors: K
authors: Nakamura
authors: Jun
authors: J
authors: Hayashi
authors: Hikaru
authors: H
authors: Watarai
authors: Takumi
authors: T
authors: Yasumoto
authors: Mitsuaki
authors: M
authors: Sadahiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D003198:Computer Simulation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D013906:Thoracoscopy / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Computed tomography; Segmentectomy; Simulation; Subsegmentectomy; Thoracoscopy