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James R Landreneau - One of the best experts on this subject based on the ideXlab platform.
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anatomic Segmentectomy for stage i non small cell lung cancer comparison of video assisted thoracic surgery versus open approach
The Journal of Thoracic and Cardiovascular Surgery, 2009Co-Authors: Matthew J Schuchert, Brian L Pettiford, Arman Kilic, John M Close, Arjun Pennathur, James R Landreneau, Ghulam Abbas, Omar Awais, Robert JackAbstract:Objectives Anatomic Segmentectomy is increasingly being considered as a means of achieving an R0 resection for peripheral, small, stage I non–small-cell lung cancer. In the current study, we compare the results of video-assisted thoracic surgery (n = 104) versus open (n = 121) Segmentectomy in the treatment of stage I non–small-cell lung cancer. Methods A total of 225 consecutive anatomic segmentectomies were performed for stage IA (n = 138) or IB (n = 87) non–small-cell lung cancer from 2002 to 2007. Primary outcome variables included hospital course, complications, mortality, recurrence, and survival. Statistical comparisons were performed utilizing the t test and Fisher exact test. The probability of overall and recurrence-free survival was estimated with the Kaplan-Meier method, with significance being estimated by the log-rank test. Results Mean age (69.9 years) and gender distribution were similar between the video-assisted thoracic surgery and open groups. Average tumor size was 2.3 cm (2.1 cm video-assisted thoracic surgery; 2.4 cm open). Mean follow-up was 16.2 (video-assisted thoracic surgery) and 28.2 (open) months. There were 2 perioperative deaths (2/225; 0.9%), both in the open group. Video-assisted thoracic surgery Segmentectomy was associated with decreased length of stay (5 vs 7 days, P P = .012) compared with open Segmentectomy. Overall mortality, complications, local and systemic recurrence, and survival were similar between video-assisted thoracic surgery and open Segmentectomy groups. Conclusions Video-assisted thoracic surgery Segmentectomy can be performed with acceptable morbidity, mortality, recurrence, and survival. The video-assisted thoracic surgery approach affords a shorter length of stay and fewer postoperative pulmonary complications compared with open techniques. The potential benefits and limitations of Segmentectomy will need to be further evaluated by prospective, randomized trials.
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anatomic Segmentectomy for stage i non small cell lung cancer in the elderly
The Annals of Thoracic Surgery, 2009Co-Authors: Arman Kilic, Matthew J Schuchert, Brian L Pettiford, Arjun Pennathur, James R Landreneau, James D Luketich, Rodney J LandreneauAbstract:Background Anatomic Segmentectomy for stage I non-small cell lung cancer (NSCLC) offers the potential of surgical cure with preservation of lung function. This may be of particular importance in elderly NSCLC patients with declining cardiopulmonary status and a limited life expectancy. Methods The study compared outcomes of 78 elderly patients (aged > 75 years) with stage I NSCLC undergoing Segmentectomy and 106 undergoing lobectomy for stage I NSCLC from 2002 to 2007. Primary outcome variables included perioperative morbidity and mortality, hospital course, recurrence patterns, and survival. Results Age, gender, tumor histology, and surgical approach were similar between groups. Comorbidities were similar except for a higher incidence of chronic obstructive pulmonary disease and diabetes in Segmentectomy patients. The tumors in the lobectomy group were significantly larger (3.5 vs 2.5 cm, p = 0.0001). Operative mortality was 1.3% for Segmentectomy and 4.7% for lobectomy. Segmentectomy patients had fewer major complications (11.5% vs 25.5%, p = 0.02). There were no differences in median hospitalization (7 vs 6 days). The estimated overall survival at 2, 3, and 5 years was 76%, 69%, and 46% for Segmentectomy patients and 68%, 59%, and 47% for lobectomy patients ( p = 0.28). The 5-year disease-free survival was equivalent (Segmentectomy, 49.8%; lobectomy, 45.5%; p = 0.80). Conclusions Anatomic Segmentectomy can be performed safely in elderly patients with early-stage NSCLC. This approach is associated with reduced perioperative complications and comparable oncologic efficacy compared with lobectomy in older patients with a limited life expectancy.
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anatomic Segmentectomy in the treatment of stage i non small cell lung cancer
The Annals of Thoracic Surgery, 2007Co-Authors: Matthew J Schuchert, Brian L Pettiford, Samuel Keeley, Thomas A Damato, Arman Kilic, John M Close, Arjun Pennathur, Ricardo Santos, Hiran C Fernando, James R LandreneauAbstract:Background Segmentectomy for early-stage non-small cell lung cancer (NSCLC) remains controversial and has been previously associated with high local recurrence rates. We compared the outcomes of anatomic Segmentectomy with lobectomy for stage I NSCLC and investigated the impact of surgical resection margins on recurrence. Methods From 2002 to 2006, 182 anatomic segmentectomies (114 open, 68 video-assisted thoracic surgery [VATS]), were performed for stage 1A (n = 109) or IB (n = 73) NSCLC. These were compared with 246 lobectomies (1A, 114; 1B, 132). Variables analyzed included hospital course, mortality, and patterns of recurrence and survival. Results All Segmentectomy surgical margins were free of tumor (average margin, 18.2 mm). Operative time (147 versus 216 minutes; p p = 0.0003) were significantly reduced after Segmentectomy compared with lobectomy. Thirty-day mortality (1.1% versus 3.3%), total complications, disease-free recurrence, and survival were similar between Segmentectomy and lobectomy at a mean follow-up of 18.1 and 28.5 months, respectively. There were 32 recurrences after Segmentectomy (17.6%) at a mean of 14.3 months (14 locoregional [7.7%], 18 distant [9.9%]), and 89% of recurrences were seen when tumor margins were 2 cm or less. Margin/tumor diameter ratios exceeding 1 were associated with a significant reduction in recurrence rates compared with ratios of less than 1 (25.0% versus 6.2%; p = 0.0014). Conclusions Anatomic Segmentectomy can be performed safely by an open or VATS approach. Segmentectomy outcomes compare favorably with standard lobectomy for stage I NSCLC. Margin/tumor ratios of less than 1 are associated with a higher rate of recurrence. Lobectomy should be considered as primary therapy when such margins are not obtainable with Segmentectomy in the good-risk patient.
Kimihiro Shimizu - One of the best experts on this subject based on the ideXlab platform.
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Medial-basal segment (S^7)-sparing right basal Segmentectomy
General Thoracic and Cardiovascular Surgery, 2020Co-Authors: Toshiki Yajima, Seshiru Nakazawa, Kimihiro Shimizu, Akira Mogi, Takayuki Kosaka, Ken ShirabeAbstract:The technique of medial-basal segment (S^7)-sparing basal Segmentectomy has not previously been reported. Herein we report the technical details of thoracoscopic anatomical basal Segmentectomy preserving S^7 in patients with B^7ab branching pattern.
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Thoracoscopic right middle lobe Segmentectomy.
General thoracic and cardiovascular surgery, 2018Co-Authors: Toshiki Yajima, Seshiru Nakazawa, Kimihiro Shimizu, Akira Mogi, Takayuki Kosaka, Ken ShirabeAbstract:Reports of right middle lobe Segmentectomy are rare. We report here that anatomical right middle lobe Segmentectomy is a relatively simple surgical procedure and can achieve good expansion of the remnant lung for patients with a relatively large right middle lobe.
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VATS Segmentectomy: past, present, and future
General Thoracic and Cardiovascular Surgery, 2018Co-Authors: Seshiru Nakazawa, Kimihiro Shimizu, Akira Mogi, Hiroyuki KuwanoAbstract:Video-assisted thoracoscopic surgery (VATS) has gradually been implemented in thoracic surgery, and the VATS approach has now been extended to technically challenging procedures, such as Segmentectomy. The definition of VATS Segmentectomy is changing over time, and the repertoire of Segmentectomy is getting wider with increasing reports on atypical Segmentectomy. VATS Segmentectomy bears surgical, oncological, and technical advantages; however, there are still areas of controversy, particularly regarding oncological outcomes. The indication of VATS Segmentectomy is diverse and is used for treating lung cancer, metastatic lung tumors, or a variety of nonmalignant diseases. It is particularly valuable for the lung-sparing resection of deeply located small nodules or repeated surgery for multiple lung lesions. VATS Segmentectomy requires a thorough analysis of segmental anatomy and a tailored preoperative planning with the assessment of surgical margins. Technical challenges include intraoperative navigation, methods to identify and dissect the intersegmental plane, and the prevention of air leakage. This review will discuss the present state of VATS Segmentectomy, with a focus on past studies, current indications and techniques, and future view.
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Segmentectomy of the left superior segment (S6) 4 years after Segmentectomy of the left dorsobasal segment (S10).
The Journal of thoracic and cardiovascular surgery, 2017Co-Authors: Kimihiro Shimizu, Seshiru Nakazawa, Akira Mogi, Hiroyuki KuwanoAbstract:Abstract To date, repeated Segmentectomy in the same lobe has not yet been reported. Herein we report the technical details of a left superior segment (S 6 ) Segmentectomy 4 years after left dorsobasal segment (S 10 ) Segmentectomy.
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Thoracoscopic Medial-Basal Segment Segmentectomy.
The Annals of thoracic surgery, 2017Co-Authors: Kimihiro Shimizu, Kai Obayashi, Seshiru Nakazawa, Yoichi Ohtaki, Akira Mogi, Toshiteru Nagashima, Toshiki Yajima, Takayuki Kosaka, Hiroyuki KuwanoAbstract:The technical details and anatomic features of medial-basal segment (S7) Segmentectomy have not been reported. We report here thoracoscopic S7 Segmentectomy and S7a subSegmentectomy and explain the anatomic knowledge necessary to perform S7 Segmentectomy, especially the importance of recognizing bronchus (B7) branching patterns before surgery.
Katsunobu Kawahara - One of the best experts on this subject based on the ideXlab platform.
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How to manage tumor located between upper division and lingular segment "S3+S4 Segmentectomy and S3b+S4 Segmentectomy".
Journal of thoracic disease, 2017Co-Authors: Shinichi Yamashita, Katsunobu Kawahara, Takeshi Shiraishi, Yasuhiro Yoshida, Daisuke Hamatake, Akinori IwasakiAbstract:Segmentectomy is one of the treatment of choice for small-sized non-small cell lung cancer (NSCLC). Although simple Segmentectomy is feasible even if under thoracoscopy, complicated Segmentectomy which contains more than two segmental plane divisions is difficult especially thoracoscopic surgery. We here present the case of totally thoracoscopic Segmentectomy between upper division and lingular segment. In the first case, the 64-year-old female patient admitted for further examination and treatment of left lung ground glass nodule. Tumor located between upper division (S3) and lingular (S4) segment was operated by bi-Segmentectomy and intraoperative frozen section pathology showed minimally invasive adenocarcinoma. Systematic nodal dissection was followed after retrieval of specimens. A3b A3a+c, and A4 was individually divided and followed by division of B3 and B4. Finally, intersegmental veins V1+2a and V1+2d was identified between segments and V3a+b was divided. In the second case, the 76-year-old female patient with left lung nodule between upper division (S3b) and lingular (S4) segment was operated by bi-Segmentectomy. Since sealing test revealed air leakage from resected segmental planes, fibrin glue was applied to stop air leakage and direct suturing by 4-0 prolene between S3a+S3c and S5 was performed. Target lesion between upper division and lingular segments may be resected safely if appropriate demarcation lines are identified regardless of without highly sophisticated imaging systems.
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clinical impact of Segmentectomy compared with lobectomy under complete video assisted thoracic surgery in the treatment of stage i non small cell lung cancer
Journal of Surgical Research, 2011Co-Authors: Shinichi Yamashita, Satoshi Yamamoto, Masao Chujo, Yozo Kawano, Michiyo Miyawaki, Keita Tokuishi, Kentaro Anami, Katsunobu KawaharaAbstract:Background Segmentectomy for small or early stage non-small cell lung cancer (NSCLC) has been controversial. Further, video-assisted thoracic surgery (VATS) for lung cancer was accepted during the past decade. We here compared the outcome between VATS Segmentectomy and VATS lobectomy for stage I NSCLC. Methods In the retrospective study, 109 consecutive patients in stage I underwent surgery at Oita University Hospital (Oita, Japan) between September 2003 and October 2008. VATS Segmentectomy was performed in 38 patients and VATS lobectomy with systemic lymphadenectomy was performed in 71 patients. After clinicopathologic factors were compared in both groups, local recurrence rates and survivals were compared. Results Five of 38 VATS Segmentectomy and eight of 71 VATS lobectomy patients relapsed during the follow-up period (median 27.5 mo). In the relapsed patients after VATS Segmentectomy, three (7.9%) were local recurrences and two (5.3%) were distant metastases. On the other hand, four (5.6%) were local recurrence and four (5.6%) were distant metastases in the VATS lobectomy group. There was no significant difference between the two groups. Furthermore, there was no difference in recurrence-free and overall survival between Segmentectomy and lobectomy. Conclusions Although the sample size is small, VATS Segmentectomy is one of the appropriate procedures for stage I NSCLC.
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Surgical procedure of thoracoscopic and video-assisted anatomical Segmentectomy for small peripheral lung cancer
Nihon Geka Gakkai zasshi, 2005Co-Authors: Katsunobu KawaharaAbstract:Recently, small peripheral lung cancers which is indicated limited resection are frequently found by HRCT or PET. The limited resection for lung cancer includes thoracic and video-assisted anatomical Segmentectomy (VATS Segmentectomy) and wedge resection of the lung parenchyma. In anatomical Segmentectomy, intra-plumonary lymph nodes are dissected, on the other hand, those lymph nodes can not be dissected in wedge resection. Consequently, Segmentectomy will be radical procedure for lung cancer compared with wedge resection. Thoracic surgeons are required to perform anatomical Segmentectomy for small peripheral lung cancer. The anatomical Segmentectomy is not familiar procedure for recent thoracic surgeons. Thoracic surgeons should be skilled in that procedures. This is a review of basic procedures of VATS Segmentectomy for lung cancer for young thoracic surgeones.
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video assisted thoracoscopic surgery vats Segmentectomy for small peripheral lung cancer tumors intermediate results
Surgical Endoscopy and Other Interventional Techniques, 2004Co-Authors: Takeshi Shiraishi, Takayuki Shirakusa, Akinori Iwasaki, M Hiratsuka, Satoshi Yamamoto, Katsunobu KawaharaAbstract:We investigated the feasibility and suitability of video-assisted thoracoscopic surgery (VATS) Segmentectomy for curing selected non–small cell lung cancer (NSCLC) with this less invasive technique. We performed VATS Segmentectomy for small (<20 mm) peripherally located tumors and pathologically confirmed lobar lymph node–negative disease by frozen-section examination during surgery. Of the 34 patients who underwent this limited resection, 22 were treated with complete hilar and mediastinal lymph node dissection (intentional group), whereas 12 patients who were deemed to be high risk in their toleration for lobectomy underwent VATS Segmentectomy with incomplete hilar and mediastinal lymph node dissection (compromised group). The surgical and clinical parameters were evaluated and compared with those of Segmentectomy under standard thoracotomy to evaluate the technical feasibility of VATS Segmentectomy. We found that VATS Segmentectomy could be performed safely with a nil mortality rate and acceptably low morbidity. The mean period of observation was relatively short at 656.7 ± 572.1 and 783.4 ± 535.8 days in the intentional and compromised groups, respectively. At the time of writing, all intentional patients remain alive and free of recurrence. There were two cases of non–cancer-related death in the compromised group. Clinical data indicated that VATS Segmentectomy caused the same number or fewer surgical insults compared with Segmentectomy under standard thoracotomy. The present results are intermediate only; the rate of long-term survival and the advantages of the less invasive procedure still need further investigation. Nevertheless, we believe that VATS Segmentectomy with complete lymph node dissection is a reasonable treatment option for selected patients with small peripheral NSCLC.
Scott J Swanson - One of the best experts on this subject based on the ideXlab platform.
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Video-assisted thoracic surgery (VATS) Segmentectomy: state of the art.
Minerva chirurgica, 2015Co-Authors: Abby White, Scott J SwansonAbstract:The role of video-assisted thoracic surgery (VATS) in the treatment of lung cancer is well established. However a topic of current debate centers on the role of parenchymal-sparing operations, Segmentectomy in particular, in the treatment of non-small cell lung cancer (NSCLC). Current reports in the literature draw dramatically different conclusions regarding the efficacy and safety of Segmentectomy versus lobectomy for NSCLC. Two randomized controlled trials are currently underway to shed further light on this topic. Lobectomy remains the standard of care, with VATS approaches demonstrating improved morbidity. Experience in literature suggests Segmentectomy is a viable approach for patients with limited cardiopulmonary reserve, or who would otherwise be unable to tolerate lobectomy. Thus, VATS Segmentectomy is a vital skill in the armamentarium of today's thoracic surgeon. Minimally invasive approaches to Segmentectomy are accomplished with a certain amount of finesse and a thorough understanding of the associated anatomy. A technical description of VATS Segmentectomy is provided.
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survival after Segmentectomy and wedge resection in stage i non small cell lung cancer
Journal of Thoracic Oncology, 2013Co-Authors: Cardinale B Smith, Scott J Swanson, Grace Mhango, Juan P WisniveskyAbstract:Introduction: Although lobectomy is considered the standard surgical treatment for stage IA non–small-cell lung cancer (NSCLC), wedge resection or Segmentectomy are frequently performed on patients who are not lobectomy candidates. The objective of this study was to compare survival among patients with stage IA NSCLC, who are undergoing these procedures. Methods: Using the Surveillance, Epidemiology and End Results registry, we identified 3525 patients. We used logistic regression to determine propensity scores for patients undergoing Segmentectomy, based on the patient's preoperative characteristics. Overall and lung cancer-specific survival of patients treated with wedge resection versus Segmentectomy was compared after adjusting, stratifying, or matching patients based on propensity score. Results: Overall, 704 patients (20%) underwent Segmentectomy. Analyses, adjusting for propensity scores, showed that Segmentectomy was associated with significant improvement in overall (hazard ratio: 0.80, 95% confidence interval: 0.69–0.93) and lung cancer-specific survival (hazard ratio: 0.72, 95% confidence interval: 0.59–0.88) compared with wedge resection. Similar results were obtained when stratifying and matching by propensity score and when limiting analysis to patients with tumors sized less than or equal to 2 cm, or aged 70 years or younger. Conclusions: These results suggest that Segmentectomy should be the preferred technique for limited resection of patients with stage IA NSCLC. The study findings should be confirmed in prospective studies.
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Segmentectomy for Lung Cancer
Seminars in thoracic and cardiovascular surgery, 2010Co-Authors: Scott J SwansonAbstract:Experience reported in the literature increasingly supports the notion that Segmentectomy is comparable with lobectomy for small tumors (≤2 cm), provided that the lesion is located centrally and affords a 2-cm parenchymal surgical margin. In a recent retrospective study that compared video-assisted thoracic surgery (VATS) lobectomy to VATS Segmentectomy, the authors concluded that Segmentectomy yields excellent oncological results with comparable morbidity, mortality, locoregional recurrence, and 3-year survival. Moreover, patients in both surgical groups were discharged after similar length hospital stays although patients undergoing VATS Segmentectomy had worse pulmonary function before surgery. Perceived difficulties with new applications of minimally invasive surgeries disappear as experience increases, permitting application to technically more challenging operations. A technical description of VATS Segmentectomy is provided, including 2 new methods for ensuring the exact delineation of the fissure.
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thoracoscopic Segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage i lung cancer
The Journal of Thoracic and Cardiovascular Surgery, 2009Co-Authors: Mark Shapiro, Todd S Weiser, Juan P Wisnivesky, Cynthia Chin, Michael Arustamyan, Scott J SwansonAbstract:Objective As thoracoscopic lobectomy becomes widely applied for treatment of non–small cell lung cancer, thoracoscopic Segmentectomy remains controversial for patients with small stage I lung cancers. Questions remain regarding safety, morbidity, mortality, and recurrence rate. This study compared outcomes between thoracoscopic Segmentectomy and lobectomy. Methods Retrospective review was undertaken of patients who underwent thoracoscopic Segmentectomy or lobectomy for clinical stage I non–small cell lung cancer between January 2002 and February 2008. Indications for Segmentectomy were tumor smaller than 3 cm, limited pulmonary reserve, comorbidities, and peripheral tumor location. Results Thirty-one patients underwent Segmentectomy and 113 underwent lobectomy. Patients after Segmentectomy had worse mean forced expiratory volume in 1 second than after lobectomy (83% vs 92%, P = .04). There were no differences in mean number of nodes (10) and nodal stations (5) resected. Segmentectomy and lobectomy groups had similar median chest tube durations (2 vs 3 days, P = .18), stays (both 4 days), total complications, recurrence rates, and survivals at mean follow-ups of 22 and 21 months, respectively. Lobectomy group had 1 30-day death; Segmentectomy group had none. There were 5 (17.2%) recurrences after Segmentectomy and 23 (20.4%) after lobectomy ( P = .71), with locoregional recurrence rates of 3.5% and 3.6%, respectively. Conclusion Thoracoscopic Segmentectomy is a safe option for experienced thoracoscopic surgeons treating patients with small stage I lung cancers. No significant difference in oncologic outcome was seen between thoracoscopic Segmentectomy and thoracoscopic lobectomy. Lymph node dissection could be performed as effectively during Segmentectomy as lobectomy.
Hiroyuki Kuwano - One of the best experts on this subject based on the ideXlab platform.
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VATS Segmentectomy: past, present, and future
General Thoracic and Cardiovascular Surgery, 2018Co-Authors: Seshiru Nakazawa, Kimihiro Shimizu, Akira Mogi, Hiroyuki KuwanoAbstract:Video-assisted thoracoscopic surgery (VATS) has gradually been implemented in thoracic surgery, and the VATS approach has now been extended to technically challenging procedures, such as Segmentectomy. The definition of VATS Segmentectomy is changing over time, and the repertoire of Segmentectomy is getting wider with increasing reports on atypical Segmentectomy. VATS Segmentectomy bears surgical, oncological, and technical advantages; however, there are still areas of controversy, particularly regarding oncological outcomes. The indication of VATS Segmentectomy is diverse and is used for treating lung cancer, metastatic lung tumors, or a variety of nonmalignant diseases. It is particularly valuable for the lung-sparing resection of deeply located small nodules or repeated surgery for multiple lung lesions. VATS Segmentectomy requires a thorough analysis of segmental anatomy and a tailored preoperative planning with the assessment of surgical margins. Technical challenges include intraoperative navigation, methods to identify and dissect the intersegmental plane, and the prevention of air leakage. This review will discuss the present state of VATS Segmentectomy, with a focus on past studies, current indications and techniques, and future view.
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Segmentectomy of the left superior segment (S6) 4 years after Segmentectomy of the left dorsobasal segment (S10).
The Journal of thoracic and cardiovascular surgery, 2017Co-Authors: Kimihiro Shimizu, Seshiru Nakazawa, Akira Mogi, Hiroyuki KuwanoAbstract:Abstract To date, repeated Segmentectomy in the same lobe has not yet been reported. Herein we report the technical details of a left superior segment (S 6 ) Segmentectomy 4 years after left dorsobasal segment (S 10 ) Segmentectomy.
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Thoracoscopic Medial-Basal Segment Segmentectomy.
The Annals of thoracic surgery, 2017Co-Authors: Kimihiro Shimizu, Kai Obayashi, Seshiru Nakazawa, Yoichi Ohtaki, Akira Mogi, Toshiteru Nagashima, Toshiki Yajima, Takayuki Kosaka, Hiroyuki KuwanoAbstract:The technical details and anatomic features of medial-basal segment (S7) Segmentectomy have not been reported. We report here thoracoscopic S7 Segmentectomy and S7a subSegmentectomy and explain the anatomic knowledge necessary to perform S7 Segmentectomy, especially the importance of recognizing bronchus (B7) branching patterns before surgery.
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Thoracoscopic Subsuperior Segment Segmentectomy
The Annals of thoracic surgery, 2017Co-Authors: Kimihiro Shimizu, Kai Obayashi, Seshiru Nakazawa, Yoichi Ohtaki, Akira Mogi, Toshiteru Nagashima, Toshiki Yajima, Takayuki Kosaka, Hiroyuki KuwanoAbstract:To date, anatomic subsuperior segment (S∗) Segmentectomy has not yet been reported. Herein we report the technical details of thoracoscopic anatomic S∗ Segmentectomy and the anatomic features of the S∗.
