Bronchopulmonary segments are anatomic, functional and surgical units of lung. There are 10 bronchopulmonary segments in the right lung and 8-9 segments on the left. Left upper lobe is much bigger than the right upper lobe. It has lingula which is tongue like projection while middle lobe is seen only in right lung. Each segment has its own tertiary bronchus and artery but vein and lymphatics run on the edge. Anatomical lung segmentectomy is a common surgical procedure in thoracic surgery and has gained more importance following COVID pandemic for lung preservation. Minimal invasive surgical approaches such as video-assisted thoracoscopic surgery (VATS) and robotic surgery have been commonly used for segmentectomy. Since lung segments are approached from peripheral aspect, therefore, anatomical segmentectomy requires a thorough assessment of each patient’s thoracic anatomy, notably of the peripheral intersegmental veins. Although thoracic surgeons are familiar with the branching patterns of pulmonary vessels and bronchi, however, this remains a challenge because pulmonary anatomy has numerous variations and anomalies.3D-CT imaging is a powerful tool for thoracic surgeons to determine pulmonary anatomy in a more intuitive manner and help surgeons better understand the pulmonary anatomy of each patient before and during surgical procedures. With the development of 3D printing technology and its introduction into the field of surgery, the relationship between lung anatomy and lung lesion can be visualised preoperatively, which can help the surgeon to determine the specific location of the lesion. Accurate determination of intersegmental planes is a challenge in anatomical segmentectomy, and multiple methods have been proposed including developing inflation/ deflation lines and injecting indocyanine green either intravenously or intrabronchially. Virtual-assisted lung mapping (bronchoscopic multi-spot dye marking) may be an optional approach for optimal anatomical segmentectomy to identify intersegmental planes and obtain adequate resection margins.
Audience Take Away Notes
- 3D anatomy of bronchopulmonary segment
- Identification of segment margins
- Approach to various segments in VATS and robotic thoracic surgeries
- This knowledge will enhance the efficiency of the audience and not only improve outcome but will also reduce complication rate