An innovative and safe method to manage the inter-segmental plane using the "Inserted Multilateral Cutting Method" in pulmonary segmentectomy.

Background: Management of the intersegmental plane (ISP) remains a challenge in lung segmentectomy to minimize intra- or postoperative complications and damage to the lungs. The purpose of this study was to assess the novel method's clinical feasibility and safety for segmentectomy.

Methods: A total of 205 patients who underwent video-assisted thoracoscopic surgery (VATS) segmentectomy from May 2018 to January 2020 were retrospectively reviewed. We classified the patients into two groups according to the surgical procedure: the Inserted Multilateral Cutting Method (IMCM) group and the non-IMCM group using staplers or energy instruments to manage the ISPs. The operative characteristics and postoperative complications were compared between the two groups.

Results: All patients in the two groups underwent VATS segmentectomy with free margins. There were no significant differences in clinicopathological characteristics between the two groups. Compared with the non-IMCM group, the IMCM group was significantly associated with less intraoperative blood loss (85.5±64.3 vs. 106.6±64.7 mL; P=0.04), shorter operation time (101.7±22.2 vs. 118.3±30.9 minutes; P<0.01) and duration of chest drainage (3.8±1.3 vs. 4.2±1.4 days; P=0.03). No significant difference was found in hospital stays, prolonged air leaks, and pulmonary infection between the two groups. On multivariate analysis, the IMCM method for managing the intersegment plane was verified to be significantly correlated with lower postoperative complications (odds ratio: 0.263, P=0.01).

Conclusions: The IMCM during VATS segmentectomy showed excellent feasibility and safety and is worthy of popularization and application.