Complex VATS segmentectomy: S8 segmentectomy

Abstract

Nowadays, lung sparing resections are more and more performed and thoracic surgeons should be well aware of operative technics for all kinds of segmentectomy. Despite the fact that there is no typical infra lobar anatomical resection, S8 segmentectomy is one of the most difficult lung segmentectomies because of the highly variable peripheral pulmonary anatomies and the difficulty of identifying the intersegmental plane. In case of intentional segmentectomy for early-stage lung cancer, multidisciplinary team and innovation are often required to ensure oncological safety: preoperative localization of the target lesion for adequate margins +3D reconstructions for operative planification + indocyanine green (ICG) with fluorescent camera for intersegmental plane + frozen section on lymph node and margins. Regarding the operative technic, good exposure is mandatory to perform with good oncological rules this challenging procedure. Minimally invasive surgery is now the gold standard rather than the open thoracotomy. The multi-port access is helpful in VATS but this operation can be done with uniportal approach if the surgeon masters it. As there is no S7 on the left side, the left S8 segmentectomy is more often proposed than on the right side. We describe here the technique of the total multiport VATS left S8 lung segmentectomy.