Yamagata University Hospital

Thoracoscopic Segmentectomy

Thoracoscopic Segmentectomy Using 3D CT Simulation


General Thoracic Surgery


In the field of respiratory surgery, lobectomy is now generally performed thoracoscopically, but in this department, we also conduct thoracoscopic segmentectomy. There are five pulmonary lobes, three on the right and two on the left. The standard method for treatment of lung cancer is lobectomy. Recently, however, with the spread of CT, early detection has been increasing. As a standard procedure, removing a large lobe even in the case of a small lung tumor is coming to be considered as excessive. Among these lesions, ground glass opacity lesions are thought to have an especially high possibility of being early lung cancer, and the view is spreading that it's acceptable to remove a small area without being limited to the earlier standard procedure. With this point of view, partial resection has come to be performed in a small area on the surface of the lung. However, if it happens to go deep into the lungs, partial resection is difficult. On the other hand, it's a waste to excise the whole pulmonary lobe when there are only five on both sides. This is when segmental resection is chosen.


The five lobes are further divided into areas 18 and segmental resection is the removal of these areas. However, pulmonary segmental resection is typically difficult due to the complex involvement of vessels and bronchi, so it's typically performed with thoracotomy. Yamagata University has been pioneering lung segmentectomy using an endoscope (thoracoscope). Until then, there were a very few reports of thoracoscopic segmentectomy, but these were limited to the so-called simple procedures. This is because for the greater part of segmentectomies, the blood vessels are complicated and it's difficult to incise the actual lung where each patient has differing anatomy, so it was considered necessary to perform a normal thoracotomy. However, there's a contradiction in that this results in a large surgical wound to resect a small area. Ideally resection of a small area should leave only a small scar. To solve this problem, the hospital started pioneering surgery simulation using 3D images produced by computer processing of CT.


By mastering computer processing, accurately ascertaining the anatomy, and setting the area for resection correctly, it became possible to excise any complicated area whatever the type with a thoracoscope. Each segment is further divided into two or three subsegments, therefore the lungs are actually divided into 42 subsegments. With the addition of unique innovations, we can now freely combine these areas and subsegments for resection. It's possible to determine the optimal resection area for each patient, enabling so-called minute tailor-made surgery. So far we've conducted 300 segmentectomies. From an era of surgery requiring a large incision for even a small tumor to a small incision for a small tumor, it has become possible to perform operations that make sense from the physical point of view. The patient can now drink water on the evening of the day of surgery, and walking has become possible. We'll be pleased if you choose our precise and accurate thoracoscopic segmentectomy.


Relevant diseases


This operation is suited mainly to lung cancer with tumor size of 2cm or less, metastatic lung cancer, and benign diseases. Depending on the characteristics of the CT shadow, lung cancers of around 3cm can also be removed.Also we are performing this operation even for babies or children so as to reserve the lung as much as possible.


Record of treatment using thoracoscopic segmentectomy


Everybody who received lung cancer surgery at the hospital was discharged in good health. Nearly 70% of patients with a thoracotomy tube can have it removed the first postoperative day. Our long-term results are excellent. One hundred percent of cases involved a complete cure, with 5-year survival rate without recurrence, and with absolutely no signs of recurrence. Also, with lung cancer of a size where normally lobectomy would be necessary, there are cases where only segmental resection can be performed due to advanced age or insufficient lung function. In these cases, the 5-year survival rate without recurrence is 95.3%, which is very good. We see this as proof that the settings for resection area using CT simulation at the hospital are correct. Of course, the results of the peritoneoscopic lobectomy are also good, with a 5-year survival rate without recurrence of 97.2% and a 10-year survival rate of 94.1%


These excellent results are regarded as the pinnacle of thoracic surgery overseas, and they're attracting global attention, with numerous presentations being adopted every year at academic conferences. Now, we're increasing our activities towards wider adoption of the procedure, providing instruction in the operation, lectures and so on at hospitals overseas.


Thoracoscopic Segmentectomy Using 3D CT Simulation