Butterfly-Needle Video-Assisted Thoracoscopic Segmentectomy

Objective A pulmonary segmentectomy is requires the identification of the segmental planes, making it technically more difficult than a lobectomy. Therefore, we present a new method that uses a butterfly needle to distinguish the intersegmental plane under video-assisted thoracoscopic surgery (VATS). Methods From May 2005 to August 2008, 15 patients underwent anatomic segmentectomy using VATS. In this approach, a working port 4 to 7 cm in length was made in the fifth intercostal space. Additional 1.2-cm thoracic ports were made in the seventh intercostal space on the anterior axillary line and the ninth intercostal space on the posterior axillary line. Each segment was selectively isolated, and the targeted bronchovascular pedicle was divided. For the segmentectomy, the lung was deflated, and the pulmonary artery and vein to the involved segment were divided. The segmental bronchus was divided using a stapling device. Using a butterfly needle, oxygen/air (1–2 L) was used to inflate the involved segment, and the involved segment was severed and removed using electrocautery or a stapling device. The raw surface was covered with an absorbable sealing material such as polyglycolic acid to prevent air leaks. Results Using this method, apical segment of the right upper lobe (S1), apical posterior segment of the left upper lobe (S1 + 2), upper division, and posterior segment of the right upper lobe (S2), superior segment of the right or left lower lobe (S6), and basal segmentectomies could be performed with VATS. However, the technique did not work in one patient with severe emphysematous changes, because the plane was not readily identifiable. Conclusions Butterfly-needle video-assisted segmentectomy is a useful technique. Selective segmental inflation allows the intersegmental plane to be identified completely under the surgeon's control, eliminating the need for an anesthesiologist to pass a bronchoscope or insufflate the lung in a particular manner.