VATS Left S8 Lung Segmentectomy With Radiological Coil and ICG
The author used blunt dissection to control the anterior part of the
fissure and opened it with a stapler. The next step consists of
identifying the arterial branches for S8. They followed the artery and
performed a station 12 lymph node dissection. This lymph node was sent
in frozen section and went back as normal. In the case of suspicious
cells being found, the author would have performed a lobectomy.
the time of this video, the author didn’t have 3D reconstruction in
routine. Since they had doubt in front of these two arterial branches,
they decided to check vascularization with the help of indocyanine green
before cutting the controlled artery. Thanks to a fluorescent camera,
they could visualize the vascularized parenchyma. They saw the lesion
crossing the demarcation line highlighting the need to expand the
resection and to cut the artery at the first level controlled with the
The segmental resection seemed to be oncologically satisfactory with sufficient margins. After the artery, they took the bronchus. They also sent to frozen section the station 12 lymph node to eliminate a more advanced disease than supposed. Care was taken not to injure the artery and V6 during dissection. After controlling the bronchus for S8, they clamped it and checked with an inflation test, which allowed them to verify S9-10 and S6 good ventilation. Just under the bronchus, they dissected the superior basilar vein. Before stapling the parenchyma, bronchovascular stumps were released to ensure removal in the operative specimen. The intersegmental lines were marked with electrocoagulation to separate S8 from S9-10 and S8 from S6.
The specimens were removed with the
lesion in the middle of the resection, warranting security margins. The
author controlled stumps of the artery, the bronchus, and the vein, then
looked into the good expansion of the remaining segments.