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Use of multi-detector row angiography for the arrangement of video-assisted modified segmental resection

^a Department of Thoracic Surgery, Tokai University Hachioji Hospital, 1838 Isikawa, Hachioji, Tokyo 192-0032, Japan
^b Department of Thoracic Surgery, Tokai University School of Medicine, Kanagawa, Japan

Received 11 September 2008; received in revised form 4 April 2009; accepted 24 April 2009.

^_* Corresponding author. Tel.: +81 0426 39 1111; fax: +81 0426 39 1111. (Email: yamada.shunsuke{at}hachioji-hosp.tokai.ac.jp).

Background: Video-assisted modified segmentectomy is segmental resection using an end-stapler without regards to anatomical broncho-segmental planes. This procedure is effective for deep pulmonary lesions, and preserves pulmonary function better as compared to lobectomy. However, the biggest disadvantage of this approach is the inability to manually palpate the lung. It is difficult to determine the staple line for pulmonary division during surgery as the tumour is located near the border of the burdened segments. This study evaluated whether multi-detector row computed tomographic angiography could contribute to the preoperative arrangement of video-assisted modified segmentectomy. Patients and methods: Video-assisted modified segmentectomy was planned for nine patients with deep pulmonary tumours measuring 3 cm or smaller (Clinical T1N0M0 lung cancer, n = 4; metastatic lung tumour, n = 4 and undiagnosed lesions suspicious for lung cancer, n = 1). All patients underwent contrast-enhanced multi-detector row computed tomography preoperatively to determine the vessels that were to be detached and the line for dividing the pulmonary parenchyma. Results: All the lesions were resected with safe surgical margins under video view in keeping with the preoperative plan. Conclusion: Our experience suggests that multi-detector row computed tomographic angiography provides information for determining the division of the pulmonary vessels and lung parenchyma in video-assisted segmentectomy.

Key Words: Multi-detector row angiography • Segmental resection • Video-assisted thoracic surgery