Prevalence and anatomical characteristics of subsuperior segment in lung lower lobe

Prevalence and anatomical characteristics of medial-basal segment in right lung

OBJECTIVES

The anatomic features and surgical techniques focusing on the right medial-basal segment (RS7) are few reported. This study aimed to accurately define the new nomenclature and classifications of B7 anatomy, elucidate its prevalence and anatomical characteristics and summarize the surgical outcomes.

METHODS

Between August 2019 and February 2022, 5023 patients were admitted for pulmonary nodules. Their chest computed tomography images were obtained. All of the images were reconstructed in 3 dimensions. The RS7 were screened according to their new definition and statistically analysed for their anatomical characteristics.

RESULTS

The bronchovascular anatomy of S7 can be newly classified into 6 types: B7a type, B7p type, B7o type, B7t type, BX7a type and BX7t type. The B7 anterior to the inferior pulmonary vein (IPV) was B7a (a, anterior) (3617/5023, 72%). The B7 posterior to IPV was B7p (p, posterior) (306/5023, 6.1%). The B7 over IPV was B7o (o, over) (904/5023, 18%). The B7 through IPV was B7t (t, through) (7/5023, 0.14%). An abnormal origin of B7 was named the BX7 type. The BX7 anterior to IPV sharing a common trunk with B8 was named BX7a (a, anterior) (176/5023, 3.5%). The BX7 through IPV originated from B10 and was named BX7t (t, through) (13/5023, 0.26%). 0.2% (12/5023) of patients had the nodules in RS7 and underwent RS7 surgery.

CONCLUSIONS

The variation pattern of B7 is far more complex than expected. The results of this study can help surgeons better understand S7 and perform segmentectomies more accurately.

Application of three-dimensional (3D) reconstruction in the treatment of video-assisted thoracoscopic complex segmentectomy of the lower lung lobe: A retrospective study

Background

An increasing number of lung ground-glass nodules (GGNs) have been detected ever since low-dose computer tomography started growing in popularity. Three-dimensional (3D) reconstruction technology plays a critical role in lung resection, especially in segmentectomy. In this study, we explore the role of 3D reconstruction in thoracoscopic complex segmentectomy of lower lung lobe.

Methods

A total of 97 patients who underwent complex segmentectomy of lower lung lobe from January 2021 to March 2022 were retrospectively analyzed. We divided these patients into a 3D group (n = 42) and a routine group (n = 55) based on preoperative 3D reconstruction or without this procedure. The demographics of patients and GGNs were collected and perioperative outcomes were compared between the two groups.

Results

All of the baseline characteristics between the groups were comparable (all P > 0.05). There was no 30-day postoperative mortality and conversion in the two groups. The operation time of the 3D group was significantly shorter than that of the routine group (111.4 ± 20.8 min vs. 127.1 ± 32.3 min, P = 0.007). The number of stapler reloads during surgery in the 3D group was less than that in the routine group (9.0 ± 2.2 vs. 10.4 ± 2.6, P = 0.009). The rate of air leakage on postoperative days 1–3 was lower in the 3D group (11.9% vs. 30.9%, P = 0.027). In addition, the resection margins of all patients in the 3D group were adequate, while four patients in the routine group had inadequate resection margins, although there was no statistically significant difference (P = 0.131). Intraoperative blood loss, postoperative drainage, postoperative hospital stay, pneumonia/atelectasis, and hemoptysis were similar between the two groups.

Conclusions

For performing complex segmentectomy of the lower lung lobe, the procedure of 3D reconstruction may shorten the operation time, decrease the number of stapler reloads, prevent postoperative air leakage, and guarantee a safe surgical margin. Therefore, 3D reconstruction is recommended for complex segmentectomy of the lower lung lobe.