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Comparison of various lung intersegmental plane identification methods

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Abstract

Keeping a sufficient surgical margin free of tumor is important to prevent local recurrence in lung segmentectomy. Accurate identification of the intersegmental plane is essential to achieve adequate surgical margins. Traditionally, the inflation–deflation method was used to identify the intersegmental plane. However, in recent years, various intersegmental plane identification methods, including systemic indocyanine green injection, have been reported and shown to be useful. The purpose of this review was to evaluate the identification rates, advantages, and disadvantages of various intersegmental identification methods in lung segmentectomy. There are primarily six methods: inflation–deflation method, selective segmental inflation, endobronchial dye injection, virtual-assisted lung mapping, systemic indocyanine green injection, and pure oxygen method. These are broadly classified into those that use bronchi and pulmonary arteries anatomically and those that use air and dye technically. In this review, all methods showed relatively high identification rates. Moreover, high identification rates were expected, especially with systemic indocyanine green injection and the pure oxygen method. Each method has its advantages and disadvantages as varying situations entail different methods. It is necessary to select and apply them effectively; therefore, further improvement for each method will be required in the future.

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Abbreviations

CT:

Computed tomography

JCOG:

Japanese Clinical Oncology Group

WJOG:

West Japan Oncology Group

CALGB:

Cancer and Leukemia Group B

ICG:

Indocyanine green

COPD:

Chronic obstructive pulmonary disease

VATS:

Video-assisted thoracic surgery

VAL-MAP:

Virtual-assisted lung mapping

N2O:

Nitrous oxide

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Authors and Affiliations

  1. Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Ken Onodera, Jun Suzuki, Tomohiro Miyoshi, Kenta Tane, Joji Samejima, Keiju Aokage & Masahiro Tsuboi

Authors
  1. Ken Onodera
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  2. Jun Suzuki
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  3. Tomohiro Miyoshi
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  4. Kenta Tane
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  5. Joji Samejima
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  6. Keiju Aokage
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  7. Masahiro Tsuboi
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Contributions

(I) Conception and design: KO, MT. (II) Administrative support: JS, TM, KT, JS, KA, MT. (III) Provision of study materials or patients: KO, JS. (IV) Collection and assembly of data: KO. (V) Data analysis and interpretation: KO. (VI) Manuscript writing: All authors. (VII) Final approval of manuscript: All authors.

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Correspondence to Ken Onodera.

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Onodera, K., Suzuki, J., Miyoshi, T. et al. Comparison of various lung intersegmental plane identification methods. Gen Thorac Cardiovasc Surg 71, 90–97 (2023). https://doi.org/10.1007/s11748-022-01885-5

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  • DOI: https://doi.org/10.1007/s11748-022-01885-5

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