eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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1/2021
vol. 16
 
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abstract:
Original paper

Novel technique for identification of the pulmonary intersegmental plane using manual jet ventilation during pulmonary segmentectomy

Shima Taguchi
1
,
Noboru Saeki
1
,
Atsushi Morio
1
,
Ryuji Nakamura
1
,
Satoshi Kamiya
1
,
Tsuyoshi Ikeda
1
,
Kyoko Oshita
1
,
Hiroshi Hamada
1
,
Yoshihiro Miyata
2
,
Morihito Okada
2
,
Yasuo M. Tsutsumi
1

  1. Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
  2. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
Videosurgery Miniinv 2021; 16 (1): 169–174
DOI: https://doi.org/10.5114/wiitm.2020.95919
Online publish date: 2020/06/01
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Introduction
For successful pulmonary segmentectomy, the identification of boundaries between segments is important. Previous measures include tracing the intersegmental vessels by staining with a dye via the affected pulmonary artery or bronchus and inflating with oxygen via a high frequency ventilator. However, problems with these methods have been reported.

Aim
We developed a novel method using a manual jet ventilator (MJV) and investigated its efficacy in identification of the pulmonary intersegmental plane.

Material and methods
Patients underwent MJV for pulmonary segmentectomy in the period from January 2013 to December 2017 at our institution. The patients’ characteristics, resected segments, availability of clear resection planes, and complications associated with MJV from medical records were investigated. A questionnaire survey was conducted with the surgeons on the effectiveness of lung segment identification using MJV.

Results
Of 199 cases of planned pulmonary segmentectomy, 171 cases with descriptions of identified intersegmental planes were analyzed. Of these, 152 (89%) cases showed a clear boundary. There were 19 cases where the exact boundaries were not clearly identified, but segmentectomy was still performed. Furthermore, we found that identification of the right upper lobes was difficult (p = 0.0028). A subjective questionnaire was answered by the 12 surgeons who performed the procedures. All 12 responded that MJV was very effective or effective regarding clarity, safety, shorter identification time, and shorter resection time.

Conclusions
MJV enabled surgeons to more easily and safely identify the pulmonary intersegmental plane, thereby suggesting that MJV has clinical significance during pulmonary segmentectomy.

keywords:

pulmonary segmentectomy, manual jet ventilation, fiberoptic bronchoscope, identification of the intersegmental plane
  
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