The RS8 thoracoscopic anatomical segmentectomy using arterial-ligation-alone method to identify the intersegmental plane. The pink lung parenchyma demarcates the segment to be resected, the dark red lung parenchyma demarcates the lung to be left intact. The virtual, and first- and second-real intersegmental planes appeared, and their consistency was confirmed

ASVIDE ◽  
2020 ◽  
Vol 7 ◽  
pp. 142-142
Author(s):  
Hong-Hao Fu ◽  
Zhen Feng ◽  
Meng Li ◽  
Hui Wang ◽  
Wan-Gang Ren ◽  
...  
Keyword(s):  
Lung Parenchyma ◽  
Arterial Ligation ◽  
Intersegmental Plane

Uniportal VATS S9 segmentectomy: The ligamentum-based approach

2021 ◽  
Keyword(s):  
Lung Parenchyma ◽  
Safe Alternative ◽  
Basal Segment ◽  
Intersegmental Plane

Isolated resection of the lateral-basal segment (S9) is uncommon, and it is considered one of the most complex anatomic segmentectomies. First, the segmental arterial and venous supply is located deeply in the lung parenchyma, making the dissection difficult. Second, the cuboidal shape of the lateral basilar segment hampers the identification of the intersegmental plane. Although identifying the segmental arterial branches is easier from a fissure-based technique, the ligamentum-based approach emerges as a valid and safe alternative in cases of a fused fissure.

scholarly journals The arterial-ligation-alone method for identifying the intersegmental plane during thoracoscopic anatomic segmentectomy

2020 ◽  
Vol 12 (5) ◽  
pp. 2343-2351
Author(s):  
Hong-Hao Fu ◽  
Zhen Feng ◽  
Meng Li ◽  
Hui Wang ◽  
Wan-Gang Ren ◽  
...  
Keyword(s):  
Arterial Ligation ◽  
Intersegmental Plane

scholarly journals Identification of The Intersegmental Plane By Arterial-Ligation Method During Thoracoscopic Segmentectomy

2021 ◽  
Author(s):  
Heng Zhao ◽  
Haiqi He ◽  
Lei Ma ◽  
Kun Fan ◽  
Jinteng Feng ◽  
...  
Keyword(s):  
Pulmonary Ventilation ◽  
Pure Oxygen ◽  
Lung Nodules ◽  
Peripheral Vein ◽  
Arterial Ligation ◽  
Thoracic Drainage ◽  
Intersegmental Plane ◽  
The Mean ◽  
Segmental Arteries ◽  
Ligation Method

Abstract Purpose The purpose of this study is to explore the feasibility of identifying the intersegmental plane by arterial ligation alone during thoracoscopic anatomical segmentectomy. Methods We selected 35 patients with peripheral small lung nodules who underwent thoracoscopic anatomical segmentectomy between May and December 2020. First, the targeted segmental arteries were distinguished and ligated during the operation. Then, bilateral pulmonary ventilation was performed with pure oxygen to fully inflate the entirety pulmonary lobes. After waiting for a while, the intersegmental plane appeared. Finally, the intersegmental plane was observed using thoracoscopy after indocyanine green was injected into the peripheral vein. The intersegmental planes determined by these two methods were compared. Results Thirty-four patients underwent segmental resection and one patient finally underwent lobectomy. The intersegmental planes were successfully observed in all patients using the arterial ligation method. The time from contralateral pulmonary ventilation to the appearance of the intersegmental plane was 13.7±3.2 min (6-19 min). The intersegmental planes determined by the arterial ligation method and the fluorescence method were comparable. After the operation, CT examinations showed that the remaining lung segments of all patients were well inflated. The mean duration of closed thoracic drainage was 3.1±0.9 days. Conclusion The arterial ligation method can be used to determine the intersegmental plane in anatomical segmentectomy. The method is feasible, reliable, and safe.

Uniportal thoracoscopic lateral and posterior (S9+10) segmentectomy using a modified intersegmental tunneling procedure

2021 ◽  
Keyword(s):  
Lung Parenchyma ◽  
Pulmonary Vessel ◽  
Previous Version ◽  
Intersegmental Plane

The lateral and posterior basal (S9+10) segmentectomy is one of the most challenging operations because it requires exposure and recognition of pulmonary vessel branches and bronchi that are located deep in the lung parenchyma. To perform this difficult operation appropriately, even via a uniportal approach, we adopted a modified version of the intersegmental tunneling procedure. Intersegmental tunneling followed by division of the intersegmental plane between S6 and S9-10 was performed before the division of the A9+10 in the modified version. In addition to the clear recognition of the dominant vessels and bronchi permitted by the tunneling procedure, we were able to divide them smoothly using a stapler in the modified version, although the tip of the inserted stapler stuck to the lung parenchyma in the previous version. This method might be universally preferable, even for less experienced surgeons, when they perform this challenging operation.

scholarly journals Determination of initial airtightness after anatomical laser segmentectomy in an ex vivo model

2021 ◽  
Author(s):  
Andreas Kirschbaum ◽  
Andrijana Ivanovic ◽  
Thomas Wiesmann ◽  
Nikolas Mirow ◽  
Christian Meyer
Keyword(s):  
Ex Vivo ◽  
Lung Parenchyma ◽  
Ex Vivo Model ◽  
Intersegmental Plane ◽  
Pulmonary Pathology ◽  
Laser Group ◽  
Healthy Lung Tissue ◽  
Laser Fibre ◽  
Healthy Lung

AbstractIf a pulmonary pathology can be removed by anatomical segmentectomy, the need for lobectomy is obviated. The procedure is considered oncologically equivalent and saves healthy lung tissue. In every segmentectomy, lung parenchyma must be transected in the intersegmental plane. Using an ex vivo model based on porcine lung, three transection techniques (monopolar cutter + suture, stapler, and Nd:YAG laser) are to be compared with respect to their initial airtightness. At an inspiratory ventilation pressure of 25 mbar, all three preparations were airtight. Upon further increase in ventilation pressure up to 40 mbar, the laser group performed best in terms of airtightness. Since thanks to its use of a laser fibre, this technique is particularly suitable for minimally invasive surgery; it should be further evaluated clinically for this indication in the future.

Quantitative Microscopic Comparison of the Organization of the Lung in Transgenic Mice Expressing Transforming Growth Factor-α (TGF-α)

1996 ◽  
Vol 54 ◽  
pp. 14-15
Author(s):  
C. G. Plopper ◽  
C. Helton ◽  
A. J. Weir ◽  
J. A. Whitsett ◽  
T. R. Korfhagen
Keyword(s):  
Growth Factor ◽  
Pulmonary Fibrosis ◽  
Transgenic Mice ◽  
Blood Vessels ◽  
Lung Parenchyma ◽  
Lung Maturation ◽  
Alveolar Air ◽  
Parenchymal Tissue ◽  
Air Space ◽  
Conducting Airways

A wide variety of growth factors are thought to be involved in the regulation of pre- and postnatal lung maturation, including factors which bind to the epidermal growth factor receptor. Marked pulmonary fibrosis and enlarged alveolar air spaces have been observed in lungs of transgenic mice expressing human TGF-α under control of the 3.7 KB human SP-C promoter. To test whether TGF-α alters lung morphogenesis and cellular differentiation, we examined morphometrically the lungs of adult (6-10 months) mice derived from line 28, which expresses the highest level of human TGF-α transcripts among transgenic lines. Total volume of lungs (LV) fixed by airway infusion at standard pressure was similar in transgenics and aged-matched non-transgenic mice (Fig. 1). Intrapulmonary bronchi and bronchioles made up a smaller percentage of LV in transgenics than in non-transgenics (Fig. 2). Pulmonary arteries and pulmonary veins were a smaller percentage of LV in transgenic mice than in non-transgenics (Fig. 3). Lung parenchyma (lung tissue free of large vessels and conducting airways) occupied a larger percentage of LV in transgenics than in non-transgenics (Fig. 4). The number of generations of branching in conducting airways was significantly reduced in transgenics as compared to non-transgenic mice. Alveolar air space size, as measured by mean linear intercept, was almost twice as large in transgenic mice as in non-transgenics, especially when different zones within the lung were compared (Fig. 5). Alveolar air space occupied a larger percentage of the lung parenchyma in transgenic mice than in non-transgenic mice (Fig. 6). Collagen abundance was estimated in histological sections as picro-Sirius red positive material by previously-published methods. In intrapulmonary conducting airways, collagen was 4.8% of the wall in transgenics and 4.5% of the wall in non-transgenic mice. Since airways represented a smaller percentage of the lung in transgenics, the volume of interstitial collagen associated with airway wall was significantly less. In intrapulmonary blood vessels, collagen was 8.9% of the wall in transgenics and 0.7% of the wall in non-transgenics. Since blood vessels were a smaller percentage of the lungs in transgenics, the volume of collagen associated with the walls of blood vessels was five times greater. In the lung parenchyma, collagen was 51.5% of the tissue volume in transgenics and 21.2% in non-transgenics. Since parenchyma was a larger percentage of lung volume in transgenics, but the parenchymal tissue was a smaller percent of the volume, the volume of collagen associated with parenchymal tissue was only slightly greater. We conclude that overexpression of TGF-α during lung maturation alters many aspects of lung development, including branching morphogenesis of the airways and vessels and alveolarization in the parenchyma. Further, the increases in visible collagen previously associated with pulmonary fibrosis due to the overexpression of TGF-α are a result of actual increases in amounts of collagen and in a redistribution of collagen within compartments which results from morphogenetic changes. These morphogenetic changes vary by lung compartment. Supported by HL20748, ES06700 and the Cystic Fibrosis Foundation.

Pulmonary hair embolism in a rescued free-ranging Eurasian otter Lutra lutra in Kinmen, Taiwan

2020 ◽  
Vol 142 ◽  
pp. 55-61
Author(s):  
WT Li ◽  
YL Chiang ◽  
TY Chen ◽  
CL Lai
Keyword(s):  
Foreign Body ◽  
Traumatic Injury ◽  
Lung Parenchyma ◽  
Giant Cells ◽  
Hair Shaft ◽  
Lutra Lutra ◽  
Lung Lobe ◽  
Eurasian Otter ◽  
Foreign Body Giant Cells ◽  
Free Ranging

Eurasian otters Lutra lutra are listed as Near Threatened on the IUCN Red List and are imperiled by habitat loss, water pollution, and poaching. Harassment and attacks by stray animals are also recognized threats to the health of wild Eurasian otters. Pulmonary hair embolism is a possible complication in animals with deep traumatic injury, but to date no cases have been reported in wildlife. A free-ranging, adult male Eurasian otter was rescued due to severe emaciation and multiple bite wounds. The otter died 3 d after rescue and was necropsied. Grossly, a 1.5 × 1.5 × 1.5 cm firm nodule was observed in the left cranial lung lobe. Histologically, a fragment of hair shaft surrounded by multinucleated foreign body giant cells was observed in a medium-sized vein, and extensive eosinophilic infiltration was noted in the adjacent vascular wall and lung parenchyma. Based on the gross and histological findings, the pulmonary lesion was consistent with eosinophilic pneumonia and vasculitis induced by hair embolism. The presence of well-formed multinucleated foreign body giant cells and eosinophils may imply a late stage of foreign body reaction, and thus the presumptive source of hair embolism is an animal bite. This is the first report of pulmonary hair embolism associated with animal bite in a rescued free-ranging Eurasian otter.

Pentoxifylline and Oxypurinol: Potential Drugs to Prevent the “Cytokine Release (Storm) Syndrome” Caused by SARS-CoV-2?

2020 ◽  
Vol 26 (35) ◽  
pp. 4515-4521
Author(s):  
Francisco J. López-Iranzo ◽  
Ana M. López-Rodas ◽  
Luis Franco ◽  
Gerardo López-Rodas
Keyword(s):  
Lung Parenchyma ◽  
Interstitial Tissue ◽  
Cytokine Release ◽  
Phase I Clinical Trials ◽  
Infected People ◽  
Tnf Α ◽  
Transient Loss ◽  
Anti Inflammatory ◽  
And Control ◽  
Inflammatory Action

Background: COVID-19, caused by SARS-CoV-2, is a potentially lethal, rapidly-expanding pandemic and many efforts are being carried out worldwide to understand and control the disease. COVID-19 patients may display a cytokine release syndrome, which causes severe lung inflammation, leading, in many instances, to death. Objective: This paper is intended to explore the possibilities of controlling the COVID-19-associated hyperinflammation by using licensed drugs with anti-inflammatory effects. Hypothesis: We have previously described that pentoxifylline alone, or in combination with oxypurinol, reduces the systemic inflammation caused by experimentally-induced pancreatitis in rats. Pentoxifylline is an inhibitor of TNF-α production and oxypurinol inhibits xanthine oxidase. TNF-α, in turn, activates other inflammatory genes such as Nos2, Icam or IL-6, which regulate migration and infiltration of neutrophils into the pulmonary interstitial tissue, causing injury to the lung parenchyma. In acute pancreatitis, the anti-inflammatory action of pentoxifylline seems to be mediated by the prevention of the rapid and presumably transient loss of PP2A activity. This may also occur in the hyperinflammatory -cytokine releasing phase- of SARS-CoV-2 infection. Therefore, it may be hypothesized that early treatment of COVID-19 patients with pentoxifylline, alone or in combination with oxypurinol, would prevent the potentially lethal acute respiratory distress syndrome. Conclusion: Pentoxifylline and oxypurinol are licensed drugs used for diseases other than COVID-19 and, therefore, phase I clinical trials would not be necessary for the administration to SARS-CoV-2- infected people. It would be worth investigating their potential effects against the hyperinflammatory response to SARS-CoV-2 infection.

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