title: Totally thoracoscopic pulmonary anatomic segmentectomies: technical considerations.
abstract: BACKGROUND
  While video-assisted thoracic surgery (VATS) lobectomies are being increasingly accepted, VATS segmentectomies are still considered as technically challenging. With the renewed interest for sublobar resection in the management of early stage lung carcinomas, the thoracoscopic approach may have a major role in a near future. We report our technique and results.
  
  
  METHODS
  Totally thoracoscopic anatomic segmentectomiy, i.e., using only endoscopic instrumentation and video-display without utility incision, was attempted on 117 patients (51 males and 66 females), aged 18 to 81 years (mean: 62 years). The indication was a clinical N0 non-small cell lung carcinoma in 69 cases, a solitary metastasis in 17 cases and a benign lesion in 31 cases. The following segmentectomies were performed: right apicosuperior [26] right superior [10], right basilar [18], lingula sparing left upper lobectomy [15], left apicosuperior [11], lingula [7], left superior [14], left basilar [13] and subsegmental resection [3]. Segmentectomy was associated with a radical lymphadenectomy in 69 cases.
  
  
  RESULTS
  There were 5 conversions to thoracotomy. The mean operative time was 181±52 minutes, the mean intraoperative blood loss was 77±81 cc. There were 12 postoperative complications (11.7%). The median postoperative stay was 5.5±2.2 days. Out of the 69 patients operated on for a cN0 lung carcinoma, 6 were finally upstaged.
  
  
  CONCLUSIONS
  Totally thoracoscopic anatomic pulmonary segmentectomies are feasible and have a low complication rate.
authors.affiliation: Thoracic Department, Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014 Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Gossot
authors.forename: Rym
authors.initials: R
authors.lastname: Zaimi
authors.forename: Ludovic
authors.initials: L
authors.lastname: Fournel
authors.forename: Madalina
authors.initials: M
authors.lastname: Grigoroiu
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Brian
authors.forename: Charles
authors.initials: C
authors.lastname: Neveu
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