Posterior approach to thoracoscopic pulmonary segmentectomy of the dorsal basal segment: A single-institute retrospective review

Abstract Objective Anatomic resection of the dorsal area of the basal segment of the lower lobe is difficult because of the deep location of vessels and bronchi in the parenchyma. This study aimed to describe a novel technique for port-access thoracoscopic segmentectomy of the dorsal (S10) and lateral dorsal segments (S9+10). Methods This retrospective study analyzed 20 patients who underwent S10 and S9+10 thoracoscopic segmentectomy via a posterior approach between January 2004 and March 2016. In this approach, the lung parenchyma between S6 and S10 was divided along V6b,c from the dorsal side of the lower lobe, which exposed the targeted bronchus (B10, B9+10) and artery (A10, A9+10) and enabled anatomic S10 and S9+10 segmentectomy. Results Of the 20 patients, 15 had lung cancer, 3 had metastases, and 2 had benign nodules. The number of segmentectomies of the right S10, right S9+10, left S10, and left S9+10 was 5, 5, 1, and 9, respectively. Median operative time was 165 minutes (range, 107-276 minutes). The median duration of chest tube insertion was 1 day (range, 1-2 days). One patient had atelectasis. Median hospital stay was 6 days (range, 3-11 postoperative days). No recurrence or mortality was observed during the median follow-up period of 46 months. Conclusions The posterior approach for port-access thoracoscopic segmentectomy at S10 or S9+10 is technically challenging, but in our hands it has been feasible. It exposes the targeted bronchus (B10, B9+10) and artery (A10, A9+10) and enables anatomic S10 and S9+10 segmentectomy while avoiding inessential parenchymal splitting from the major fissure.