A segmental labeling technique for non-intubated thoracoscopic anatomical segmentectomy

Precise pulmonary segmentectomy as lung sparing surgery has been recognized as an alternative of lobectomy for early-stage lung cancer or undiagnosed small nodules in selected patients. Besides, uniportal and non-intubated/ tubeless thoracoscopic segmentectomy are less invasive with prompt recovery, comparing with intubated general anesthesia, which contributes significantly to precision medicine (1-3). The chance of segmentectomy is minimal if a segment is too small, or it is located between neighboring segments (4). One of the major challenges of complete segmentectomy is the identification of the intersegmental plane. Transbronchial indocyanine green injection allows identification of the intersegmental lines and planes (5), which consists of ligation of the segmental vein and injection of indocyanine green through the segmental bronchus (6). Then both the surface and parenchyma of the lung are stained with easily recognized segmental borderlines