Video-Atlas of VATS Pulmonary Sublobar Resections

Description

The Video-Atlas of Pulmonary Sublobar Resections aims to be a reference multimedia book for Thoracic Surgeons. Mainly focused on operative technical aspects, each individual segmentectomy and many combinations are described. Each chapter opens with anatomical 3D reconstructions of the segment and its bronchoscopic anatomy. Then, the main steps for performing the procedure, that are illustrated in high-definition (HD) video-clips and figures, are described. Expert authors highlight specifical tips & tricks for succesfully performing the resection, and include anatomical variations that also illustrate with HD video-clips. This illustrated guide provides thoracic surgeons with an incredibly useful tool for learning and improving their technique in sublobar resections. Videos and more: Download the free Springer Multimedia App - Scan dedicated images in this book to stream videos or access and download supplementary material. Prologue Contents Part I: General Considerations and Technical Aspects 1: Indications for Sublobar Resection in the Treatment of Non-Small Cell Lung Cancer (NSCLC) 1.1 Introduction 1.2 Elective Sublobar Resection 1.2.1 Short- and Intermediate-Term Outcomes 1.2.2 Long-Term Outcomes for Ground Glass Tumors 1.2.3 Long-Term Outcomes for Small (≤2 cm) Solid Tumors 1.2.4 Decision-Making for Elective Sublobar Resection 1.3 Compromise Sublobar Resection 1.3.1 Older Patients 1.3.1.1 Short- and Intermediate-Term Outcomes 1.3.1.2 Long-Term Outcomes 1.3.2 Patients with Limited Pulmonary Reserve 1.3.2.1 Short- and Intermediate-Term Outcomes 1.3.2.2 Long-Term Outcomes 1.3.3 Decision-Making for Compromise Sublobar Resection 1.4 Technical Issues 1.4.1 Anatomic Location 1.4.2 Resection Margin 1.4.3 Spread Through Air Spaces (STAS) 1.5 Conclusion References 2: Anatomical and Radiological Correlation 2.1 Introduction 2.2 Preoperative Radiological Techniques 2.3 Understanding Segmental Anatomy at CT 2.4 Segmental Anatomy by Lobe 2.5 Right Upper Lobe 2.6 Middle Lobe 2.7 Right Lower Lobe 2.8 Left Upper Lobe 2.9 Left Lower Lobe References 3: Bronchoscopic Anatomy 3.1 Introduction 3.2 Tracheal Anatomy 3.3 Right Bronchial Tree Anatomy 3.4 Left Bronchial Tree Anatomy 3.5 Segmental Anomalies of the Tracheobronchial Tree References 4: Intersegmental Plane: Selective Inflation or Clamp of Target Segment 4.1 Introduction 4.2 Techniques 4.2.1 Inflation–Deflation Method 4.2.1.1 Introduction 4.2.1.2 Operative Steps 4.2.1.3 Specific Technique Considerations 4.2.2 Selective Deflation: Slip-Knot Technique 4.2.2.1 Introduction 4.2.2.2 Operative Steps 4.2.2.3 Specific Technique Considerations 4.2.3 Selective Inflation: Jet Flow 4.2.3.1 Introduction 4.2.3.2 Operative Steps 4.2.3.3 Specific Technique Considerations 4.2.4 Selective Inflation: Catheter or Needle 4.2.4.1 Introduction 4.2.4.2 Operative Steps 4.2.4.3 Specific Technique Considerations 4.3 Conclusions 4.4 Summary Video References 5: Intersegmental Plane: Indocyanine Green 5.1 Preoperative Evaluation 5.2 Operative Steps 5.2.1 Exposure and Division of the Segmental Arteries 5.2.2 Exposure and Division of the Segmental Bronchus 5.2.3 Dissection of the Hilum 5.2.4 Systemic Injection of Indocyanine Green and Confirmation of the Intersegmental Border 5.2.5 Division of the Lung Parenchyma 5.2.6 Hilar Lymph Node Dissection 5.3 Video Summary (Video 5.4) References 6: Intersegmental Plane: Virtual-Assisted Lung Mapping (VAL-MAP) 6.1 General Introduction of VAL-MAP 6.1.1 Principles and Indications of VAL-MAP (Video 6.1) 6.1.2 Roles of VAL-MAP in Segmentectomy (Video 6.2) 6.1.3 Variations of VAL-MAP (Video 6.3) 6.2 Steps of the VAL-MAP Procedure 6.2.1 Planning for Surgery and Lung-Map Design (Video 6.4) 6.2.2 Virtual Bronchoscopy (Video 6.5) 6.2.3 Bronchoscopic Mapping Procedure (Video 6.6) 6.2.4 Post-Mapping CT and 3D Reconstruction (Video 6.8) 6.3 Steps of Sublobar Lung Resection Assisted by VAL-MAP 6.3.1 Segmentectomies Assisted by VAL-MAP (Video 6.9) 6.3.2 Extended Segmentectomy (Video 6.10) 6.3.3 Combined Subsegmentectomy (Video 6.11) 6.3.4 VAL-MAP 2.0: Adjustment of the Resection Lines Under Fluoroscopic View (Video 6.12) References 7: Lymphadenectomy During Sublobar Resections 7.1 Introduction 7.2 Right lymphadenectomy: Operative Steps 7.3 Left Lymphadenectomy: Operative Steps References Part II: Right Lung Sublobar Resections 8: Right Apical Segmentectomy (S1) 8.1 Anatomical Landmarks 8.2 Operative Steps 8.2.1 Dissection and Division of the Apical Segmental Artery (A1) (Video 8.1) 8.2.2 Dissection and Division of the Apical Segmental Bronchus (B1) (Video 8.2) 8.2.3 Dissection and Division of the Apical Segmental Vein (V1) (Video 8.3) 8.2.4 Identification and Division of the Intersegmental Plane (Video 8.4) 8.3 Summary Video References 9: Right Posterior Segmentectomy (S2) 9.1 Anatomical Landmarks 9.2 Operative Steps 9.2.1 Major Fissure Opening 9.2.2 Ascending A2 Control and Section 9.2.3 Exposure of the Central Vein and Its Branches 9.2.4 Control and Section of V2a + b and V2c 9.2.5 B2 Control and Section 9.2.6 Identification, Control and Section of A2rec 9.2.7 Identification and Section of the Intersegmental Plane 9.2.8 Removal of Segment 2 9.2.9 Intersegmental, Hilar, and Mediastinal Lymphadenectomy 9.2.10 Closure 9.3 Summary Video References 10: Right Anterior Segmentectomy (S3) 10.1 Anatomical Landmarks 10.2 Operative Steps 10.2.1 Exposure of the Hilar Structures: Central Vein and Branches, Main Pulmonary Artery, Truncus Superior and Intermedius 10.2.2 Minor Fissure Assessment 10.2.3 Control and Section of V3a + b + c 10.2.4 Control and Section of A3 10.2.5 Control and Section of B3 10.2.6 Identification and Section of the Intersegmental Plane 10.2.7 Removal of S3 10.2.8 Lymphadenectomy 10.2.9 Closure 10.3 Summary Video References 11: Right Upper Segmentectomy (S6) 11.1 Anatomical Landmarks 11.2 Operative Steps 11.2.1 Exposure of the Inferior Pulmonary Vein. Dissection and Division of V6 11.2.2 Division of the Major Fissure and Access to the Pulmonary Artery in the Fissure 11.2.3 Exposure and Section of A6 11.2.4 Peribronchial and Lymphatic Dissection. Bronchial Section 11.2.5 Identification and Section of the Intersegmental Plane 11.3 Summary Video References 12: Right Common Basal Segmentectomy (S7 + S8 + S9 + S10) 12.1 Anatomical Landmarks 12.2 Operative Steps During Unidirectional Approach 12.2.1 Dissection of Anterior Oblique Fissure 12.2.2 Identification of the Basilar Artery and A6 12.2.3 Identification of Basilar Bronchus and B6 12.2.4 Identification of Basilar Vein and V6 12.2.5 Intersegmental Plane Between Basilar Segment and S6 Division 12.2.6 Specimen Removal and Closure 12.3 Summary Video 12.4 Operative Steps During Bidirectional Approach 12.4.1 Dissection of Anterior Oblique Fissure 12.4.2 Identification of the Basilar Artery and A6 12.4.3 Identification of Basilar Vein and V6 12.4.4 Division of Vessels 12.4.5 Intersegmental Plane Between Basilar Segment and S6 Division 12.4.6 Basilar Bronchus Division 12.4.7 Specimen Removal and Closure 12.5 Summary Video 12.6 Permission References 13: Right Anteromedial Basal Bisegmentectomy (S7 + S8) 13.1 Anatomical Landmarks 13.2 Operative Steps 13.2.1 Pulmonary Nodule Identification 13.2.2 Division of Inferior Pulmonary Ligament 13.2.3 Dissecting Oblique Fissure and Exposing Pulmonary Artery 13.2.4 Division of Right Anteromedial Pulmonary Artery Branch (A7 + 8) (Video 13.1) 13.2.5 Division of Right Anteromedial Pulmonary Vein Branch (V7 + 8) (Video 13.2) 13.2.6 Division of Right Anteromedial Bronchus Branch (B7 + 8) (Video 13.3) 13.2.7 Identifying and Division of the Intersegmental Plane (Videos 13.4, 13.5, and 13.6) 13.3 Summary Video References 14: Right Lateroposterior Basal Bisegmentectomy (S9 + S10) 14.1 Anatomical Landmarks 14.2 Operative Steps 14.2.1 Opening Major Fissure 14.2.2 Exposure and Control of Arterial Segmental Branches. Division 14.2.3 Exposure and Control of Venous Segmental Branches. Division 14.2.4 Completion of the Intersegmental Plane Between S9 + S10 and S6 14.2.5 Bronchial Exposure and Division of B9 and B10 14.2.6 Completion of the Intersegmental Plane Between S9 + S10 and S7 + S8 14.2.7 Specimen Removal and Closure 14.3 Summary Video References Part III: Left Lung Sublobar Resections 15: Left Apicoposterior Bisegmentectomy (S1 + S2) 15.1 Anatomical Landmarks 15.2 Operative Steps 15.2.1 Anterior Hilar Dissection 15.2.2 Posterior Hilar Dissection 15.2.3 Fissure Dissection 15.2.4 Bronchovascular Segmental Ligation and Division 15.2.5 Intersegmental Parenchymal Division References 16: Left Anterior Segmentectomy (S3) 16.1 Anatomical Landmarks [1–9] 16.2 Operative Steps 16.2.1 Control and Section of V3 16.2.2 Dissection and Division of B3 16.2.3 Division of A3 16.2.4 Identification and Division of the Intersegmental Plane 16.2.5 Closure 16.3 Summary Video References 17: Left Upper Trisegmentectomy (S1 + S2 + S3) 17.1 Anatomical Landmarks 17.2 Operative Steps 17.2.1 Identification, Control and Section of V1–V3 (Video 17.1) 17.2.2 Identification, Control and Section of A1 + 2 + A3 Arteries (Video 17.2) 17.2.3 Identification, Control and Section of Rest of Arteries 17.2.4 Exposure of the LUL Bronchus and its Division B1–3 and B4–5. Section of B1–B3 17.2.5 Preparation of the Intersegmental Plane 17.2.6 Identification and Section of the Intersegmental Plane 17.2.7 Lymphadenectomy 17.3 Summary Video References 18: Lingulectomy (S4 + S5) 18.1 Anatomical Landmarks 18.2 Operative Steps 18.2.1 Dissection of the Fissure to Identify the Interlobar Pulmonary Artery 18.2.2 Dissection and Section of the Lingular Artery (A4 + 5) 18.2.3 Dissection and Section of the Lingular Vein (V4 + 5) 18.2.4 Dissection and Division of Lingular Bronchus 18.2.5 Division of Intersegmental Plane 18.3 Summary Video References 19: Left Upper Segmentectomy (S6) 19.1 Anatomical Landmarks 19.2 Operative Steps 19.2.1 Opening of the Major Fissure and Dissection and Section of the Segmental Artery (A6) 19.2.2 Exposure and Section of the Segmental Bronchus B6 19.2.3 Venous Dissection and Section (V6 and Identification of V6a) 19.2.4 Preparation of the Intersegmental Plane 19.2.5 Specimen Removal 19.2.6 Lymphadenectomy 19.2.7 Closure and Security Check 19.3 Summary Video References 20: Left Common Basal Segmentectomy (S8 + S9 + S10) 20.1 Anatomical Landmarks 20.2 Operative Steps 20.2.1 Division of Inferior Pulmonary Ligament 20.2.2 Dissection of Pulmonary Vein 20.2.3 Identification of Lower Lobe Pulmonary Arterial (PA) Anatomy 20.2.4 Division of Basilar Pulmonary Artery 20.2.5 Division of Basilar Pulmonary Vein 20.2.6 Inferior Dissection of Basilar Bronchus 20.2.7 Completion of Anterior Fissure 20.2.8 Anterior Dissection of Basilar Bronchus 20.2.9 Division of Bronchus 20.2.10 Division of Segmental Parenchyma 20.2.11 Removal of Specimen 20.2.12 Lymphadenectomy 20.3 Summary Video Reference 21: Left Anterior Basal Segmentectomy (S8) 21.1 Anatomical Landmarks 21.2 Operative Steps 21.2.1 Segmental Artery Dissection and Division 21.2.2 Segmental Bronchus Dissection 21.2.3 Segmental Bronchus Division 21.2.4 Segmental Vein Dissection and Division 21.2.5 Posterior Intersegmental Plane Division 21.2.6 Segmental Lymphadenectomy 21.2.7 Intersegmental Plane Division with S9 21.2.8 Specimen Removal and Lymph Node Dissection References 22: Left Lateroposterior Basal Bisegmentectomy (S9 + S10) 22.1 Anatomical Landmarks 22.2 Operative Steps 22.2.1 Segmental Artery Dissection and Division 22.2.2 Segmental Bronchus Dissection 22.2.3 Segmental Vein Dissection and Division 22.2.4 Posterior Intersegmental Plane Division 22.2.5 Segmental Bronchus Division 22.2.6 Segmental Lymphadenectomy 22.2.7 Anterior Intersegmental Plane Division 22.2.8 Specimen Removal and Lymph Node Dissection References Part IV: Special Combinations of Sublobar Resections 23: Right S1 + S2 Bisegmentectomy 23.1 Anatomical Landmarks 23.2 Operative Steps 23.2.1 Division of Posterior Major Fissure 23.2.2 Apical Segmental Srtery A1 23.2.3 PosteriorAascending Segmental Artery A2b 23.2.4 Apical Segmental Vein V1 23.2.5 Posterior Segmental Vein V2 23.2.6 Apical Segmental Bronchus B1 and Posterior Segmental Bronchus B2 23.2.7 Identification of Segmental Plane 23.2.8 Specimen Removal 23.2.9 Closure 23.3 Summary Video 24: Right S1 + S3 Bisegmentectomy 24.1 Anatomical Landmarks 24.2 Operative Steps 24.2.1 Pulmonary Nodule Identification (Video 24.1) 24.2.2 Vein (V1, V3b, V3a) and Minor Fissure Division (Video 24.2) 24.2.3 Minor Fissure Division 24.2.4 Artery (A1, A3) (Video 24.5) 24.2.5 Bronchi (B1, B3) (Video 24.6) 24.2.6 Intersegmental Plane Division (Video 24.7) 24.3 Summary Video References 25: Right S2 + S6 Bisegmentectomy 25.1 Anatomical Landmarks [1, 2] 25.2 Operative Steps 25.2.1 Pulmonary Nodule Identification 25.2.2 Dissection of Posterior Mediastinal Pleura 25.2.3 Hilar Dissection of S6 25.2.4 Hilar Dissection of S2 25.2.5 Individual Dissection of Intersegmental Planes of S6 and S2 25.3 Summary Video References 26: S6 + S10 Bisegmentectomy 26.1 Anatomical Landmarks 26.2 Operative Steps 26.2.1 Interlobar Artery Exposure and Major Fissure Opening 26.2.2 A6 + B6 Control and Section 26.2.3 A10 and V6 + V10 Control and Section 26.2.4 B10 Control and Section 26.2.5 Division of the Pulmonary Ligament and the Intersegmental Plane 26.2.6 Removal of Segment 6+10 26.2.7 Lymphadenectomy 26.2.8 Closure 26.3 Summary Video References 27: Left S8 + S9 Bisegmentectomy 27.1 Anatomical Landmarks 27.2 Operative Steps 27.2.1 Fissure Opening 27.2.2 A8 and A9 Dissection and Section 27.2.3 Identification and Division of B8 and B9 and Intersegmental Plane Delimitation 27.2.4 V8 and V9 Dissection and Division 27.2.5 Intersegmental Plane Division 27.2.6 Lymph Nodes Assessment 27.2.7 Closure References