Application of the simple pulmonary artery occlusion method in thoracoscopic segmentectomy: A retrospective cohort study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FANG Shaohan , PAN Gaojian , ZHU Xiaolei , LIU Hongming , LI Ning , JIANG Jie ,  GENG Guojun

Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, P. R. China;

Corresponding author：

GENG Guojun, Email: ggj622@126.com

Keywords：

Segmentectomy; surgical technique; pulmonary artery; simple artery occlusion

DOI：

10.7507/1007-4848.202409061

Video：

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Objective To explore the clinical application value of simple artery occlusion (SAO) in revealing intersegmental planes during thoracoscopic pulmonary segmentectomy. Methods A retrospective analysis was conducted on the clinical data of patients who underwent thoracoscopic pulmonary segmentectomy at the First Affiliated Hospital of Xiamen University from February 2022 to December 2023. Patients were divided into a conventional group and a SAO group based on the method used to reveal the intersegmental plane during surgery. The two groups were compared in terms of intraoperative blood loss, operation time, postoperative drainage volume, time to intubation, postoperative pulmonary air leakage, and conversion to open thoracotomy rate. Results A total of 318 patients were included. There were 181 patients in the conventional group, including 86 males and 95 females, with an average age (53.35±9.20) years, and there were 137 patients in the SAO group, including 58 males and 79 females, with an average age (55.26±11.46) years. There were no statistical differences in general patient information between the two groups (P>0.05). The SAO group had less intraoperative blood loss [MD=17.568, 95%CI (9.968, 25.168), P<0.001] and postoperative drainage volume [MD=275.587, 95%CI (188.999, 362.175), P<0.001], shorter drainage tube duration [MD=1.000, 95%CI (1.000, 2.000), P<0.001] and operation time [MD=20.709, 95%CI (16.258, 25.159), P<0.001]. The incidence of postoperative pulmonary air leakage complications in the SAO group was lower than that in the conventional group [RR=0.361, 95%CI (0.181, 0.722), P=0.003]. Conclusion SAO can reduce surgical difficulty, shorten operation time, decrease the incidence of postoperative pulmonary air leakage, and enhance the safety of anatomical pulmonary segmentectomy, making it worthy of clinical promotion and application.

Citation： FANG Shaohan, PAN Gaojian, ZHU Xiaolei, LIU Hongming, LI Ning, JIANG Jie, GENG Guojun. Application of the simple pulmonary artery occlusion method in thoracoscopic segmentectomy: A retrospective cohort study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(10): 1419-1424. doi: 10.7507/1007-4848.202409061 Copy

1.	Cao W, Tan F, Liu K, et al. Uptake of lung cancer screening with low-dose computed tomography in China: a multi-centre population-based study. EClinicalMedicine, 2022, 52: 101594.
2.	Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
3.	Kong XL, Lu J, Li PJ, et al. Technical aspects and early results of uniportal video-assisted thoracoscopic complex segmentectomy: a 30 case-series study. J Cardiothorac Surg, 2022, 17(1): 63.
4.	Ji D, Sun R, Wu Z. Effects of uniportal thoracoscopic pulmonary segmentectomy and lobectomy on patients with early-stage non-small-cell lung cancer and risk factors of postoperative complications. Am J Transl Res, 2023, 15(6): 4369-4379.
5.	Matsuura N, Igai H, Ohsawa F, et al. Novel thoracoscopic segmentectomy combining preoperative three-dimensional image simulation and intravenous administration of indocyanine green. Interact Cardiovasc Thorac Surg, 2022, 35(2): ivac064.
6.	Yang W, Liu Z, Yang C, et al. Combination of nitrous oxide and the modified inflation-deflation method for identifying the intersegmental plane in segmentectomy: a randomized controlled trial. Thorac Cancer, 2021, 12(9): 1398-1406.
7.	Fan W, Yang H, Ma J, et al. Indocyanine green fluorescence-navigated thoracoscopy versus traditional inflation-deflation approach in precise uniportal segmentectomy: a short-term outcome comparative study. J Thorac Dis, 2022, 14(3): 741-748.
8.	Qiu T, Jiao W, Zhao Y, et al. Identification of the intersegmental plane via electromagnetic navigation for anatomical segmentectomy. Thorac Cancer, 2023, 14(24): 2515-2518.
9.	Ettinger DS, Wood DE, Aisner DL, et al. Non-small cell lung cancer, version 3. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(5): 497-530.
10.	郭航, 殷均阳, 刘宇, 等. 三维重建在早期非小细胞肺癌胸腔镜下肺段切除术中的应用. 河南医学研究, 2022, 31(8): 1401-1404.Guo H, Yin JY, Liu Y, et al. Application of three-dimensional reconstruction in thoracoscopic segmentectomy of early stage non-small cell lung cancer. Henan Med Res, 2022, 31(8): 1401-1404.
11.	Bae SY, Lee H, Na KJ, et al. Computed tomography volumetric analysis for predicting postoperative lung function for segmentectomy. Interact Cardiovasc Thorac Surg, 2022, 35(2): ivac195.
12.	Fan K, Feng J, Li Y, et al. Application of three-dimensional reconstruction of left upper lung lobes in anatomical segmental resection. Thorac Cancer, 2022, 13(8): 1176-1183.
13.	Janik M, Lucenic M, Tarabova K, et al. Uniportal thoracoscopic sublobar anatomical resections for small pulmonary nodules. Bratisl Lek Listy, 2022, 123(7): 533-538.
14.	Cheng YF, Hsieh YC, Chang YJ, et al. Comparison of extended segmentectomy with traditional segmentectomy for stageⅠlung cancer. J Cardiothorac Surg, 2022, 17(1): 27.
15.	Lei X, Zhou N, Zhang H, et al. Lobe-specific analysis of sublobar lung resection for NSCLC patients with tumors≤2 cm. Cancers (Basel), 2022, 14(13): 3265.
16.	曹珲, 侍晔, 董长青, 等. 荧光反染法与膨胀萎陷法在单孔胸腔镜肺段切除术中的应用效果观察. 中国医刊, 2022, 57(1): 96-98.Cao H, Shi Y, Dong CQ, et al. Observation on the application effect of fluorescence counterstaining method and inflation deflation method in single-port thoracoscopic pulmonary segmentectomy. Chin Med J, 2022, 57(1): 96-98.
17.	Wu Z, Huang Z, Qin Y, et al. Progress in three-dimensional computed tomography reconstruction in anatomic pulmonary segmentectomy. Thorac Cancer, 2022, 13(13): 1881-1887.
18.	Sun Y, Zhang Q, Wang Z, et al. Is the near-infrared fluorescence imaging with intravenous indocyanine green method for identifying the intersegmental plane concordant with the modified inflation-deflation method in lung segmentectomy? Thorac Cancer, 2019, 10(10): 2013-2021.
19.	丁洪瑞, 钱晨, 喻竹, 等. 机器人与胸腔镜在吲哚菁绿荧光显影下肺段切除手术中的护理配合. 机器人外科学杂志(中英文), 2022, 3(4): 319-324.Ding HR, Qian C, Yu Z, et al. Nursing cooperation in robotic and thoracoscopic segmentectomy under indocyanine green fluorescence imaging. J Robot Surg (Engl Chin), 2022, 3(4): 319-324.
20.	蒋可为, 陈鹤峰, 范志强, 等. 磁导航支气管镜与肺穿刺在肺外周病变中的诊断率和安全性研究. 中国呼吸与危重监护杂志, 2023, 22(9): 640-645.Jiang KW, Chen HF, Fan ZQ, et al. A study on the diagnostic rate and safety of magnetic navigation bronchoscopy and lung puncture in peripheral pulmonary lesions. Chin J Respir Crit Care, 2023, 22(9): 640-645.
21.	Ahn S, Moon Y. A comparison of the short-term outcomes of simple and complex segmentectomy via uniportal video-assisted thoracoscopic surgery. J Thorac Dis, 2023, 15(10): 5386-5395.
22.	Yotsukura M, Okubo Y, Yoshida Y, et al. Indocyanine green imaging for pulmonary segmentectomy. JTCVS Tech, 2021, 6: 151-158.
23.	Zhang X, Li C, Jin R, et al. Intraoperative identification of the intersegmental plane: from the beginning to the future. Front Surg, 2022, 9: 948878.
24.	Zhu Y, Pu Q, Liu C, et al. Trans-inferior-pulmonary-ligament single-direction thoracoscopic RS9 segmentectomy: application of stem-branch method for tracking anatomy. Ann Surg Oncol, 2020, 27(8): 3092-3093.
25.	Ohtaki Y, Yajima T, Nagashima T, et al. Complex vs. simple segmentectomy: comparing surgical outcomes in the left upper division. Gen Thorac Cardiovasc Surg, 2022, 70(11): 962-970.
26.	Leivaditis V, Skevis K, Mulita F, et al. Advancements in the management of postoperative air leak following thoracic surgery: from traditional practices to innovative therapies. Medicina (Kaunas), 2024, 60(5): 802.
27.	Burel J, El Ayoubi M, Baste JM, et al. Surgery for lung cancer: postoperative changes and complications: what the radiologist needs to know. Insights Imaging, 2021, 12(1): 116.
28.	Zhou Y, Yu T, Zhang Y, et al. Comparison of surgical outcomes and prognosis between wedge resection and simple segmentectomy for GGO diameter between 2 cm and 3 cm in non-small cell lung cancer: a multicenter and propensity score matching analysis. BMC Cancer, 2022, 22(1): 71.
29.	Whitson BA, Groth SS, Andrade RS, et al. Survival after lobectomy versus segmentectomy for stageⅠnon-small cell lung cancer: a population-based analysis. Ann Thorac Surg, 2011, 92(6): 1943-1950.
30.	Bédat B, Abdelnour-Berchtold E, Perneger T, et al. Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study. J Cardiothorac Surg, 2019, 14(1): 189.
31.	魏海星, 朱燚宁, 王琦, 等. 改良膨胀萎陷法界定肺段间交界面的精确性评估. 中国肺癌杂志, 2020, 23(6): 526-531.Wei HX, Zhu YN, Wang Q, et al. Assessment of the accuracy of modified inflation-deflation methods for distinguishing the intersegmental border. Chin J Lung Cancer, 2020, 23(6): 526-531.
32.	Yasuura Y, Konno H, Hayakawa T, et al. Chylothorax after pulmonary resection and lymph node dissection for primary lung cancer; retrospective observational study. J Cardiothorac Surg, 2022, 17(1): 11.
33.	Jeon HW, Kim YD, Moon YK, et al. Single incision thoracoscopic right upper lobectomy with systematic lymph node dissection. J Cardiothorac Surg, 2014, 9: 66.
34.	Hwang Y, Kang CH, Kim HS, et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy on the patients with non-small cell lung cancer: a propensity score matching study. Eur J Cardiothorac Surg, 2015, 48(2): 273-278.

1. Cao W, Tan F, Liu K, et al. Uptake of lung cancer screening with low-dose computed tomography in China: a multi-centre population-based study. EClinicalMedicine, 2022, 52: 101594.
2. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
3. Kong XL, Lu J, Li PJ, et al. Technical aspects and early results of uniportal video-assisted thoracoscopic complex segmentectomy: a 30 case-series study. J Cardiothorac Surg, 2022, 17(1): 63.
4. Ji D, Sun R, Wu Z. Effects of uniportal thoracoscopic pulmonary segmentectomy and lobectomy on patients with early-stage non-small-cell lung cancer and risk factors of postoperative complications. Am J Transl Res, 2023, 15(6): 4369-4379.
5. Matsuura N, Igai H, Ohsawa F, et al. Novel thoracoscopic segmentectomy combining preoperative three-dimensional image simulation and intravenous administration of indocyanine green. Interact Cardiovasc Thorac Surg, 2022, 35(2): ivac064.
6. Yang W, Liu Z, Yang C, et al. Combination of nitrous oxide and the modified inflation-deflation method for identifying the intersegmental plane in segmentectomy: a randomized controlled trial. Thorac Cancer, 2021, 12(9): 1398-1406.
7. Fan W, Yang H, Ma J, et al. Indocyanine green fluorescence-navigated thoracoscopy versus traditional inflation-deflation approach in precise uniportal segmentectomy: a short-term outcome comparative study. J Thorac Dis, 2022, 14(3): 741-748.
8. Qiu T, Jiao W, Zhao Y, et al. Identification of the intersegmental plane via electromagnetic navigation for anatomical segmentectomy. Thorac Cancer, 2023, 14(24): 2515-2518.
9. Ettinger DS, Wood DE, Aisner DL, et al. Non-small cell lung cancer, version 3. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(5): 497-530.
10. 郭航, 殷均阳, 刘宇, 等. 三维重建在早期非小细胞肺癌胸腔镜下肺段切除术中的应用. 河南医学研究, 2022, 31(8): 1401-1404.Guo H, Yin JY, Liu Y, et al. Application of three-dimensional reconstruction in thoracoscopic segmentectomy of early stage non-small cell lung cancer. Henan Med Res, 2022, 31(8): 1401-1404.
11. Bae SY, Lee H, Na KJ, et al. Computed tomography volumetric analysis for predicting postoperative lung function for segmentectomy. Interact Cardiovasc Thorac Surg, 2022, 35(2): ivac195.
12. Fan K, Feng J, Li Y, et al. Application of three-dimensional reconstruction of left upper lung lobes in anatomical segmental resection. Thorac Cancer, 2022, 13(8): 1176-1183.
13. Janik M, Lucenic M, Tarabova K, et al. Uniportal thoracoscopic sublobar anatomical resections for small pulmonary nodules. Bratisl Lek Listy, 2022, 123(7): 533-538.
14. Cheng YF, Hsieh YC, Chang YJ, et al. Comparison of extended segmentectomy with traditional segmentectomy for stageⅠlung cancer. J Cardiothorac Surg, 2022, 17(1): 27.
15. Lei X, Zhou N, Zhang H, et al. Lobe-specific analysis of sublobar lung resection for NSCLC patients with tumors≤2 cm. Cancers (Basel), 2022, 14(13): 3265.
16. 曹珲, 侍晔, 董长青, 等. 荧光反染法与膨胀萎陷法在单孔胸腔镜肺段切除术中的应用效果观察. 中国医刊, 2022, 57(1): 96-98.Cao H, Shi Y, Dong CQ, et al. Observation on the application effect of fluorescence counterstaining method and inflation deflation method in single-port thoracoscopic pulmonary segmentectomy. Chin Med J, 2022, 57(1): 96-98.
17. Wu Z, Huang Z, Qin Y, et al. Progress in three-dimensional computed tomography reconstruction in anatomic pulmonary segmentectomy. Thorac Cancer, 2022, 13(13): 1881-1887.
18. Sun Y, Zhang Q, Wang Z, et al. Is the near-infrared fluorescence imaging with intravenous indocyanine green method for identifying the intersegmental plane concordant with the modified inflation-deflation method in lung segmentectomy? Thorac Cancer, 2019, 10(10): 2013-2021.
19. 丁洪瑞, 钱晨, 喻竹, 等. 机器人与胸腔镜在吲哚菁绿荧光显影下肺段切除手术中的护理配合. 机器人外科学杂志(中英文), 2022, 3(4): 319-324.Ding HR, Qian C, Yu Z, et al. Nursing cooperation in robotic and thoracoscopic segmentectomy under indocyanine green fluorescence imaging. J Robot Surg (Engl Chin), 2022, 3(4): 319-324.
20. 蒋可为, 陈鹤峰, 范志强, 等. 磁导航支气管镜与肺穿刺在肺外周病变中的诊断率和安全性研究. 中国呼吸与危重监护杂志, 2023, 22(9): 640-645.Jiang KW, Chen HF, Fan ZQ, et al. A study on the diagnostic rate and safety of magnetic navigation bronchoscopy and lung puncture in peripheral pulmonary lesions. Chin J Respir Crit Care, 2023, 22(9): 640-645.
21. Ahn S, Moon Y. A comparison of the short-term outcomes of simple and complex segmentectomy via uniportal video-assisted thoracoscopic surgery. J Thorac Dis, 2023, 15(10): 5386-5395.
22. Yotsukura M, Okubo Y, Yoshida Y, et al. Indocyanine green imaging for pulmonary segmentectomy. JTCVS Tech, 2021, 6: 151-158.
23. Zhang X, Li C, Jin R, et al. Intraoperative identification of the intersegmental plane: from the beginning to the future. Front Surg, 2022, 9: 948878.
24. Zhu Y, Pu Q, Liu C, et al. Trans-inferior-pulmonary-ligament single-direction thoracoscopic RS9 segmentectomy: application of stem-branch method for tracking anatomy. Ann Surg Oncol, 2020, 27(8): 3092-3093.
25. Ohtaki Y, Yajima T, Nagashima T, et al. Complex vs. simple segmentectomy: comparing surgical outcomes in the left upper division. Gen Thorac Cardiovasc Surg, 2022, 70(11): 962-970.
26. Leivaditis V, Skevis K, Mulita F, et al. Advancements in the management of postoperative air leak following thoracic surgery: from traditional practices to innovative therapies. Medicina (Kaunas), 2024, 60(5): 802.
27. Burel J, El Ayoubi M, Baste JM, et al. Surgery for lung cancer: postoperative changes and complications: what the radiologist needs to know. Insights Imaging, 2021, 12(1): 116.
28. Zhou Y, Yu T, Zhang Y, et al. Comparison of surgical outcomes and prognosis between wedge resection and simple segmentectomy for GGO diameter between 2 cm and 3 cm in non-small cell lung cancer: a multicenter and propensity score matching analysis. BMC Cancer, 2022, 22(1): 71.
29. Whitson BA, Groth SS, Andrade RS, et al. Survival after lobectomy versus segmentectomy for stageⅠnon-small cell lung cancer: a population-based analysis. Ann Thorac Surg, 2011, 92(6): 1943-1950.
30. Bédat B, Abdelnour-Berchtold E, Perneger T, et al. Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study. J Cardiothorac Surg, 2019, 14(1): 189.
31. 魏海星, 朱燚宁, 王琦, 等. 改良膨胀萎陷法界定肺段间交界面的精确性评估. 中国肺癌杂志, 2020, 23(6): 526-531.Wei HX, Zhu YN, Wang Q, et al. Assessment of the accuracy of modified inflation-deflation methods for distinguishing the intersegmental border. Chin J Lung Cancer, 2020, 23(6): 526-531.
32. Yasuura Y, Konno H, Hayakawa T, et al. Chylothorax after pulmonary resection and lymph node dissection for primary lung cancer; retrospective observational study. J Cardiothorac Surg, 2022, 17(1): 11.
33. Jeon HW, Kim YD, Moon YK, et al. Single incision thoracoscopic right upper lobectomy with systematic lymph node dissection. J Cardiothorac Surg, 2014, 9: 66.
34. Hwang Y, Kang CH, Kim HS, et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy on the patients with non-small cell lung cancer: a propensity score matching study. Eur J Cardiothorac Surg, 2015, 48(2): 273-278.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of the simple pulmonary artery occlusion method in thoracoscopic segmentectomy: A retrospective cohort study in a single center

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