Objective To explore the application of Body Tom? mobile CT combined with basic anesthesia in preoperative painless positioning of small pulmonary nodules, and evaluate its safety and effectiveness. Methods Patients using mobile Body Tom? CT to accurately locate pulmonary nodules in the Department of Thoracic Surgery of Affiliated Nanjing Brain Hospital, Nanjing Medical University from August to October 2022 were retrospectively included. Clinical data of the whole patient group were analyzed. ResultsWe finally included 30 patients with 12 males and 18 females at age of 23-71 years. The position success rate of 30 patients with small pulmonary nodules was 100.0%. Location time was 14.20±4.07 min. There was one patient of intrapulmonary hemorrhage, with no other complications such as pneumothorax, positioning needle shedding, or pleural reaction. The time from the end of positioning to the start of surgery was 12.63±5.68 min. There was no needle migration or indocyanine green overflow. All patients completed resection of small pulmonary nodules under single-port thoracoscopy, no transit to opening chest. The average operation time was 85.32±12.60 min. There was no postoperative complications, and the average postoperative chest tube retention time was 2.12±1.34 days. And the average length of hospital stay was 3.52±1.45 days. The postoperative pathological results showed that the distance from the nodules was greater than 2 cm. Conclusion Body Tom? mobile CT combined with basic anesthesia can achieve the preoperative painless, precise positioning of pulmonary nodules, effectively reduce the incidence of preoperative positioning complications, shorten the operation waiting time, ensure the safety and effectiveness of patients with preoperative pulmonary nodules positioning, and further improve the surgical comfort of patients, which has certain clinical application value.
Objective To explore the feasibility and accuracy of using indocyanine green fluorescence (ICGF) to identify the intersegmental plane after ligation of the target pulmonary vein during thoracoscopic segmentectomy. Methods From December 2022 to June 2023, the patients with pulmonary nodules undergoing video-assisted thoracoscopic anatomical segmentectomy with intersegmental plane displayed using ICGF after ligation of the target pulmonary vein by the same medical team in our hospital were collected. Preoperative three-dimensional reconstruction was used to identify the target segment where the pulmonary nodule was located and the anatomical structure of the arteries, veins, and bronchi in the target segment. The intersegmental plane was first determined by the inflation-deflation method after the target pulmonary vein was ligated during the operation. During the waiting period, the target artery and bronchus could be separated but not cut off. The inflation-deflation boundary was marked by electrocoagulation, and then ICGF was injected via peripheral vein to identify the intersegmental plane again, and the consistency of the two intersegmental planes was finally evaluated. Results Finally 32 patients were collected, including 14 males and 18 females, with an average age of 58.69±11.84 years, ranging from 25 to 76 years. The intersegmental plane determined by inflation-deflation method was basically consistent with ICGF method in all patients. All the 32 patients successfully completed uniportal thoracoscopic segmentectomy without ICGF-related complications or perioperative death. The average operation time was 98.59±20.72 min, the average intraoperative blood loss was 45.31±35.65 mL, and the average postoperative chest tube duration was 3.50±1.16 days. The average postoperative hospital stay was 4.66±1.29 days, and the average tumor margin width was 26.96±5.86 mm. Conclusion The ICGF can safely and accurately identify the intersegmental plane by target pulmonary venous preferential ligation in thoracoscopic segmentectomy, which is a useful exploration and important supplement to the simplified thoracoscopic anatomical segmentectomy.
ObjectiveTo compare the efficacy of anatomic segmentectomy combined with adjacent segmentectomy versus segmentectomy combined with extended wedge resection for deeply-located intersegmental early-stage non-small cell lung cancer (NSCLC) with a diameter≤2 cm. MethodsA retrospective analysis was conducted on the patients with deep intersegmental early-stage NSCLC (≤2 cm) who underwent sublobar resection at Nanjing Chest Hospital from March 2019 to November 2024. Preoperative three-dimensional reconstruction was performed to localize nodules and plan resection margins. Patients were divided into an anatomic group (undergoing segmentectomy with adjacent segmentectomy) and an extended group (undergoing segmentectomy with extended wedge resection). Perioperative outcomes and long-term survival of two groups were compared. ResultsA total of 95 patients were collected. Among them, there were 38 males and 57 females, aged 32 to 78 years. There were 57 patients in the anatomic group, and 38 patients in the extended group. All operations were successfully completed. Compared with the extended group, the anatomic group had a significantly lower intraoperative complication rate (0.0% vs. 10.5%, P=0.023), earlier chest tube removal [(3.05±1.64) d vs. (3.82±1.41) d, P=0.021], and shorter postoperative hospital stay [(4.23±1.73) d vs. (5.21±1.51) d, P=0.021]. There were no statistical differences between the two groups in terms of intraoperative blood loss, operative time, or postoperative complication rates (all P>0.05). The surgical margin width was significantly greater in the anatomic group than in the extended group (2.34 cm vs. 1.60 cm, P<0.001). No significant differences were observed in tumor size, number of lymph nodes dissected, number of lymph node stations, histological type, or pathological stage between the two groups (all P>0.05). With a median follow-up of 28 months, the local recurrence rate was significantly higher in the extended group (15.8%, 6/38) compared to the anatomic group (1.8%, 1/57) (P=0.015), with all recurrences in the extended group occurring at the surgical margin, while only one regional lymph node recurrence occurring in the anatomic group. There were no statistical differences in estimated 5-year disease-free survival rate (78.5% vs. 76.7%, P=0.200) or estimated overall survival rate (91.2% vs. 81.2%, P=0.980) between the two groups. ConclusionFor deeply-located intersegmental early-stage NSCLC≤2 cm, anatomic segmentectomy with adjacent segmentectomy offers superior intraoperative safety, faster postoperative recovery, lower local recurrence, and wider margins compared to segmentectomy with extended wedge resection, making it a preferable surgical approach.
