Illustrated Anatomical Segmentectomy for Lung Cancer by Hiroaki Nomori

By Hiroaki Nomori

Advances in CT have enabled us to discover small lung cancers, which has replaced the lung melanoma surgical procedure from lobectomy to a lesser lobar resection corresponding to a segmentectomy or wedge resection. whereas wedge resection is an easy technique, it has a better probability of neighborhood recurrence of melanoma than a lobectomy. nevertheless, segmentectomy is a well-known healing surgical procedure for small lung cancers. besides the fact that, it's tricky to accomplish effectively as a result of its anatomical complexity, which makes surgeons hesitant to exploit it. The publication “Illustrated Anatomical Segmentectomy for Lung melanoma” presents readers an in depth rationalization of segmentectomy with various easy-to-understand colour illustrations exhibiting the proper segmental anatomies for every trend of the approach. to raised illustrate a correct anatomical segmentectomy, the textual content exhibits information of anatomy in the course of segmentectomy. this may contain as much as 25 styles, each one of that's proven in approximately 10 illustrations.

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The third intercostal space is recommended for thoracotomy in S1-segmentectomy. 28 3 Segmentectomy of the Right Upper Lobe upper lobe middle lobe V1b V3b central vein 3 A A1 Rec. A2 V1a V4+5 Truncus intermedius artery Fig. 2 The hilum of the right upper lobe is exposed from the ventral to the dorsal side to reveal the superior pulmonary vein, truncus superior artery, upper lobar bronchus, and the bifurcation between the upper lobar bronchus and truncus intermedius bronchus. If possible, the dorsal site of the upper lobar bronchus is exposed peripherally to the bifurcation of B1 and B2, which facilitates later identification of recurrent A2.

While V1b runs towards the apex and near the lung surface, V3c runs towards the ventral side and deeply into the lung. The V1b is exposed peripherally. V1a (vein between S1a and S1b) is cut. Exposing V1b enables the identification of A1 and A3 that run dorsally and ventrally to V1b, respectively. 1 Right S1 Segmentectomy 29 Truncus intermedius A1 stump A3 V1a stump lower lobe B V1b 2 B1 Rec. A2 upper lobe Fig. 3 A recurrent A2 is verified after cutting V1a. However, this is not usually easy to identify at this point.

A needle biopsy catheter is inserted into the subsegmental bronchus through a bronchoscope and then about 1 mL of indigo carmine dye mixed with contrast medium (using for angiography) is injected into the lung tissue under fluoroscopy. If the catheter is inserted too deeply, the dye might be injected into the thoracic wall. If the needle of the forceps is too shallow, the dye might leak into the central bronchus. When injected into the appropriate position, the contrast medium mixture with dye can be visualized on fluoroscopy that moves with breathing.

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