Thoracoscopic Pulmonary Anatomic Segmentectomies

  • Dominique GossotEmail author
  • Ricard Ramos
  • Emmanuel Brian


The number of publications about video-assisted and thoracoscopic lobectomies is although these procedures are still considered as technically difficult and their learning curve is steep. This observation is even more valid for anatomic segmentectomies. Few series of video-assisted pulmonary segmentectomies have been published and totally endoscopic – so-called complete VATS – segmentectomies are even more rare. Many different techniques of thoracoscopic major pulmonary resection have been described, depending on the use or non-use of an accessory mini-thoracotomy and on the use or non-use of endoscopic instrumentation and video display. One of these techniques is the totally endoscopic approach, in which only endoscopic instruments and monitor control are used. This is the technique that will be described in this chapter. By totally endoscopic we mean: 1) 100% video display, 2) no access incision and 3) only use of trocars and endoscopic instruments. The aim of this chapter is not to discuss the oncologic validity of segmentectomies for early stage lung carcinomas but to describe the technical aspects of totally endoscopic anatomic segmentectomies (TEAS) and their results.


Superior Pulmonary Vein Lower Lobectomy Segmental Bronchus Gentle Traction Superior Segment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    McKenna R, Houck W, Fuller C (2006) Video-assisted thoracic surgery lobectomy: experience with 1100 cases. Ann Thorac Surg 81:421–426PubMedCrossRefGoogle Scholar
  2. 2.
    Yamamoto K, Ohsumi A, Kojima F, Imanishi N, Matsuoka K, Ueda M, Miyamoto Y (2010) Long-term survival after video-assisted thoracic surgery lobectomy for primary lung cancer. Ann Thorac Surg 89:353–359PubMedCrossRefGoogle Scholar
  3. 3.
    Seder C, Hanna K, Lucia V, Boura J, Kim S, Welsh R, Chmielewski G (2009) The safe transition from open to thoracoscopic lobectomy: a 5-year experience. Ann Thorac Surg 88:216–226PubMedCrossRefGoogle Scholar
  4. 4.
    Yan T, Black D, Bannon P, McCaughan B (2009) Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 27:2553–2562PubMedCrossRefGoogle Scholar
  5. 5.
    Paul S, Altorki N, Sheng S, Lee P, Harpole D, Onaitis M, Stiles B, Port J, D’Amico T (2010) Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg 139:366–378PubMedCrossRefGoogle Scholar
  6. 6.
    Atkins B, Harpole D, Mangum J, Toloza E, D’Amico T, Burfeind W (2007) Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach. Ann Thorac Surg 84:1107–1113PubMedCrossRefGoogle Scholar
  7. 7.
    Yamashita S, Chujo M, Kawano Y, Miyawaki M, Tokuishi K, Anami K, Yamamoto S, Kawahara K (2011) clinical impact of segmentectomy compared with Lobectomy Under Complete Video-Assisted ­thoracic surgery in the treatment of stage I non-small cell lung cancer. J Surg Res 166:46–51CrossRefGoogle Scholar
  8. 8.
    Okada M, Mimura T, Ikegaki J, Katoh H, Itoh H, Tsubota N (2007) A novel video-assisted anatomic segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg 133:753–758PubMedCrossRefGoogle Scholar
  9. 9.
    Schuchert M, Pettiford B, Pennathur A, Abbas G, Awais O, Close J, Kilic A, Jack R, Landreneau J, Landreneau J, Wilson D, Luketich J, Landreneau R (2009) Anatomic segmentectomy for stage I non-small-cell lung cancer: comparison of video-assisted thoracic surgery versus open approach. J Thorac Cardiovasc Surg 138:1318–1325PubMedCrossRefGoogle Scholar
  10. 10.
    Oizumi H, Kanauchi N, Kato H, Endoh M, Takeda S, Suzuki J, Fukaya K, Sadahiro M (2009) Total thoracoscopic pulmonary segmentectomy. Eur J Cardiothorac Surg 36:374–377PubMedCrossRefGoogle Scholar
  11. 11.
    Yamada S, Suga A, Inoue Y, Inoue H (2009) Use of multi-detector rox angiography for the arrangement of video-assisted modified segmental resection. Eur J Cardiothorac Surg 36:727–730PubMedCrossRefGoogle Scholar
  12. 12.
    Schuchert MJ, Pettiford BL, Keeley S, D’Amato TA, Kilic A, Close J, Pennathur A, Santos R, Fernando HC, Landreneau JR, Luketich JD, Landreneau RJ (2007) Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer. Ann Thorac Surg 84:926–933PubMedCrossRefGoogle Scholar
  13. 13.
    Wisnivesky J, Henschke C, Swanson S, Yankelevit D, Zulueta J, Marcus S, Halm E (2010) Limited resection for the treatment of patients with stage IA lung cancer. Ann Surg 251:550–554PubMedCrossRefGoogle Scholar
  14. 14.
    Schoofs J, Gossot D (2004) A neglected but frustrating ergonomic issue: the thoracoscopic trocar. Minim Invasive Ther Allied Technol 13:133–137PubMedCrossRefGoogle Scholar
  15. 15.
    Gossot D (2008) Technical tricks to facilitate totally endoscopic major pulmonary resections. Ann Thorac Surg 86:323–326PubMedCrossRefGoogle Scholar
  16. 16.
    Ikeda Y, Tamura M, Umezu H, Karube Y, Seki N, Kobayashi S, Nagai S, Miyoshi S (2003) Usefulness of mini loop retractor in video-assisted thoracic surgery. Kyobu Geka 56:199–202PubMedGoogle Scholar
  17. 17.
    Gossot D, Pryschepau M, Martinez Berenys C, Magdeleinat P (2009) Throw-off instruments for advanced thoracoscopic procedures. Interact Cardiovasc Thorac Surg 10:159–160PubMedCrossRefGoogle Scholar
  18. 18.
    Watanabe A, Ohori S, Nakashima S, Mawatari T, Inoue N, Kurimoto Y, Higami T (2009) Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg 35:775–780PubMedCrossRefGoogle Scholar
  19. 19.
    Gossot D, Girard P, Stern J, Raynaud C, Caliandro R, Debrosse D, Magdeleinat P (2009) Totally endoscopic major pulmonary resections for stage I bronchial carcinoma: initial results. Rev Mal Respir 26:961–970PubMedCrossRefGoogle Scholar
  20. 20.
    Watanabe A, Koyanagi T, Nakashima S, Higami T (2007) How to clamp the main pulmonary artery during video-assisted thoracoscopic surgery lobectomy. Eur J Cardiothorac Surg 31:129–131PubMedCrossRefGoogle Scholar
  21. 21.
    D’Amico TA (2008) Thoracoscopic segmentectomy: technical considerations and outcomes. Ann Thorac Surg 85:S716–S718PubMedCrossRefGoogle Scholar
  22. 22.
    Shapiro M, Weiser T, Wisnivesky J, Chin C, Arustamyan M, Swanson S (2009) Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer. J Thorac Cardiovasc Surg 137:1388–1393PubMedCrossRefGoogle Scholar
  23. 23.
    Gossot D, Merlusca G, Tudor A, Boudaya M, Radu C, Magdeleinat P (2009) Pitfalls related to the use of endostaplers during video-assisted thoracic surgery. Surg Endosc 23:189–192PubMedCrossRefGoogle Scholar
  24. 24.
    Gossot D (2010) Atlas of endoscopic major pulmonary resections. Springer, ParisCrossRefGoogle Scholar
  25. 25.
    Fukuhara K, Akashi A, Nakane S, Tomita E (2008) Preoperative assessment of the pulmonary artery by three-dimensional computed tomography before video-assisted thoracic surgery lobectomy. Eur J Cardiothorac Surg 34:875–877PubMedCrossRefGoogle Scholar
  26. 26.
    Nakamoto K, Omori K, Nezu K (2010) Superselective segmentectomy for deep and small pulmonary nodule under the guidance of three-dimensional reconstructed computed tomographic angiography. Ann Thorac Surg 89:877–884PubMedCrossRefGoogle Scholar
  27. 27.
    Shiraishi T, Shirakusa T, Miyoshi T, Hiratsuka M, Yamamoto S, Iwasaki A (2006) A completely thoracoscopic lobectomy/segmentectomy for primary lung cancer: technique, feasibility and advantages. Thorac Cardiovasc Surg 54:202–207PubMedCrossRefGoogle Scholar
  28. 28.
    Leshnower B, Miller D, Fernandez F, Pickens A, Force S (2010) Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure. Ann Thorac Surg 89:1571–1576PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Dominique Gossot
    • 1
    Email author
  • Ricard Ramos
    • 1
  • Emmanuel Brian
    • 1
  1. 1.Thoracic DepartmentInstitut Mutualiste MontsourisParisFrance

Personalised recommendations