Intersegmental Plane: Selective Inflation or Clamp of Target Segment

Abstract

Identification of intersegmental planes in the lung is essential for precise anatomical lung segmentectomy. Here, we introduce several methods to achieve this goal by selective inflation or clamping of the target segment, including inflation–deflation, slip-knot, jet flow, and catheter or needle. All the methods described in this chapter have some pitfalls and may be risky. For patients with pneumonia or emphysema, the conventional inflation–deflation method may lead to collateral ventilation and unclear intersegmental plane. This result can be improved by shifting to the slip-knot method. The jet flow method is straightforward, though it may be limited by the instrument used or operator skills. Selective inflation by a catheter or needle is a useful technique for thoracic surgeons; however, possible severe complications should always be considered. A safer surgical margin in segmentectomy could be obtained by selective inflation or clamping of the target segment.