%0 Journal Article
%T Division of the intersegmental plane during thoracoscopic segmentectomy: is stapling an issue?
%A Agathe Seguin-Givelet
%A Amaia Ojanguren
%A Dominique Gossot
%J SCIE-indexed Journal
%D 2016
%R 10.21037/jtd.2016.07.47
%X Although pulmonary lobectomy remains the standard treatment of operable early stage non-small cell lung cancer (NSCLC) (1), the interest for anatomic segmentectomy has grown over the past years as many elderly and/or fragile patients cannot tolerate a lobectomy but can undergo a sublobar resection, especially if performed without thoracotomy (2). For patients presenting with metastases or benign lesions, the need for sparing valid parenchyma is even more important and a thoracoscopic limited sublobar resection is more and more considered as the procedure of choice. However, segmentectomies are considered technically challenging, especially when performed by thoracoscopy. One of the most problematic steps of the operation is the division of the intersegmental plane. As the surgeon cannot rely on digital handling as he/she would do during an open peeling technique, stapling the demarcation line is becoming the preferred method. However, the use of stapling is criticized as it can plicate the parenchyma of the preserved segments (Figure 1), leading loosing valid parenchyma and impairing pulmonary re-expansion (3). Asakura et al. noted that stapling interferes with the expansion of preserved lung in comparison to mere cutting with scissors due to the visceral pleura being caught in the staple line (3). It is unclear whether this issue has any impact on the postoperative course, some authors claiming they did not noticed any difference when comparing stapling to other methods of dividing the intersegmental plane (4). For this reason, we have analyzed two postoperative features, i.e., postoperative air leak and pulmonary re-expansion, in our series of thoracoscopic segmentectomies where the intersegmental plane was divided with an endostapler
%U http://jtd.amegroups.com/article/view/8639/html