Segmentectomy Clinical Trial
Official title:
Morphologic Study of the Intersegmental Plane After Fully Thoracoscopic Segmentectomy
The objective of this study is to determine whether stapling adversely affects the pulmonary parenchyma and the vascularisation of the adjacent segments. The aim of our work is to explore by thoracic densitometry with contrast the spared segments after stapling of the intersegmental plan following a thoracoscopic segmentectomy, 3 or 6 months post-surgery. the investigator will assess venous drainage and the arterial vascularisation of the remaining segments, possible modifications of the adjacent parenchyma and whether there is a defect of pleuro-pulmonary adhesion (residual pneumothorax).
Scheduled anatomical segmentectomies are increasingly popular, due to the development of
minimally invasive techniques, the increased incidence of early-stage tumours, and the
possibility of caring for patients with compromised health and/or limited respiratory
function without compromising the oncological outcome, compared to current alternatives such
as stereotactic ablative radiotherapy (1).
One of the challenges in the development of the thoracoscopic segmentectomy technique we have
published (2-5) is the orientation (6-7) and the division of the intersegmental plane, by
contrast to segmentectomy by thoracotomy where this is helped by palpation and the manual
traction which can be used on the segment, along the intersegmental vein. The most commonly
used technique to separate two adjacent segments remains stapling, despite its high cost and
sometimes giving a less anatomical section, with a risk to encroach on the intersegmental
vein. Moreover, there can be a partial plicator of the spared segment(s) which could in
theory make them less functional.
We have however shown that the postoperative morbidity and mortality rates were much lower
than that of patients who had a thoracotomy, dropping from 42% for thoracotomies to 16% for
thoracoscopies, the surgical approach being an independent predictive factor for
postoperative complications (8).
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