Trisegmentectomy

Microlobectomy is a surgical technique conceived by Mr Joel Dunning, in Middlesbrough, UK, in 2014 and previously described in the literature. In this video, the authors demonstrate the adoption of this technique for a sublobar resection, namely a left upper division segmentectomy. The aim is to reduce the postoperative pain and use of opioids, and therefore to reduce the postoperative complications and the hospital stay. About 20% of patients who underwent lobectomy through a microlobectomy approach left the hospital on the day after the procedure.

The key principle is the adoption of 5 mm shaft instruments through 5 mm intercostal ports. The intercostal spaces are only 8 to 10 mm wide and using large ports in the intercostal space will damage the intercostal nerves causing excruciating postoperative pain, as happens with specimen retrieval through the intercostal space and the intercostal chest drain. Therefore, a larger subxiphoid port is dedicated to specimen retrieval and chest drainage.

References

1. Dunning J, Elsaegh M, Nardini M, et al. Microlobectomy: a novel form of endoscopic lobectomy. Innovations (Phila). 2017;12(4):247-253.
2. Nardini M, Bilancia R, Solli P, et al. Microlobectomy: completely portal pulmonary lobectomy. J Vis Surg. 2018;4:153.
3. ElSaegh MM, Ismail NA, Gordon J, et al. Video-assisted thoracic surgery micro pneumonectomy, a new approach. J Vis Surg. 2016;2:94.
4. Yang CF, D’Amico TA. Thoracoscopic segmentectomy for lung cancer. Ann Thorac Surg. 2012;94(2):668-681.
5. Harada H, Okada M, Sakamoto T, Matsuoka H, Tsubota N. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg. 2005;80(6): 2041-2045.