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Jixian Liu
Da Wu
Editors
Segmentectomy
for Early-Stage
Lung Cancer
3D Navigation
·北 京·
123
Segmentectomy for Early-Stage Lung Cancer
Jixian Liu • Da Wu
Editors
Segmentectomy
for Early-Stage Lung Cancer
3D Navigation
Editors
Jixian Liu
Department of Thoracic Surgery
Peking University Shenzhen Hospital
Shenzhen, China
Da Wu
Department of Thoracic Surgery
Peking University Shenzhen Hospital
Shenzhen, China
ISBN 978-981-99-0142-5 ISBN 978-981-99-0143-2 (eBook)
https://doi.org/10.1007/978-981-99-0143-2
Jointly published with Scientic and Technical Documentation Press
The print edition is not for sale in China (Mainland). Customers from China (Mainland) please order the
print book from: Scientic and Technical Documentation Press.
The translation was done with the help of articial intelligence (machine translation by the service
DeepL.com). A subsequent human revision was done primarily in terms of content.
© Scientic and Technical Documentation Press 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or
part of the material is concerned, specically the rights of reprinting, reuse of illustrations, recitation, broadcasting,
reproduction on microlms or in any other physical way, and transmission or information storage and retrieval,
electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publishers, the authors, and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publishers nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publishers remain neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore
Foreword
With the popular use of low-dose chest CT, lung cancer is being diagnosed and treated earlier
than ever. Meanwhile, the efcacy of thoracoscopic segmentectomy for early lung cancer has
been conrmed by numerous retrospective and prospective clinical studies. Segmentectomy
meets the treating criterion of lung cancer, that is, maximum resection of tumor with maximum
preservation of lung tissue.
With increasing demands in treatment and rapid developments of 3D technology in recent
years, thoracoscopic precise segmentectomy, subsegmentectomy, and combined subsegmentectomy have ourished all over the world. However, the procedure is complicated by extensive anatomical variability. With the technological advancement of 3D reconstruction
technologies, surgeons can understand the anatomical relationship between segmental vessels
and bronchi before surgeries, simplifying the segmentectomy procedure.
The book summarizes the practical experiences of the thoracic surgery team of Peking
University Shenzhen Hospital over the years by illustrating the technical details of thoracoscopic precise segmentectomy with 12 simple and practical examples. Each case comes with
CT pictures, individualized anatomical pictures of 3D reconstruction, screenshots of surgical
videos demonstrating important anatomical structures, operative videos, and most importantly,
exquisite hand-drawn pictures with detailed labeling of crucial anatomical structures.
The book simplies the technology, allowing the reader to grasp the technical essentials
with ease. At the same time, the concept of “Simplifying Standard Segmentectomy” is also
proposed. The commencement of the book in its English version will further promote the recognition and adoption of this segmentectomy technology worldwide.
Peking University People’s Hospital JunWang
Beijing, China
v
Foreword
The efcacy of the segmentectomy in the treatment of peripheral small lung cancer has been validated in global multicenter
clinical trials and recommended by NCCN, ESMO, and CACA
guidelines. Due to the complexity of this technology, the
application of this technology is limited. The difculty of segmentectomy lies in the fact that the bronchi, arterial, and
venous variations of each lung segment are obvious.
This atlas applies 3D reconstruction technology to segmentectomy, so that the procedure becomes visualized, the surgeon can clarify the complex lung segment anatomy from the
3D reconstruction pictures before the operation. The combination makes the surgical process more rened and precise,
which meets the treatment principles of lung cancer: the maxi-
mum range of resection of lesions and the maximum preservation of lung function. The combination opens up preoperative thinking models for clinicians. In the meanwhile, the atlas
staticized and simplied the dynamic surgical process, splitting the surgical process step by
step, which is convenient for clinicians to learn and review the procedure of the surgery.
Because of focus, so professional, because of persistence, so excellent, I believe that the
advent of the atlas will help clinicians master the technology of segmentectomy more easily
and will promote the technology popularizing worldwide.
President of China Anti-Cancer Association, Tianjin, China DaimingFan
International Member of USA National Academy of Medicine,
Washington, DC, USA
International Member of French National Academy of Medicine,
Paris, France
vii
Preface
I was honored to inspect the segmentectomy procedure operated by Prof. Chen Liang at
Jiangsu Provincial People’s Hospital in August 2018. Prof. Liang’s astonishingly distinct procedure caught my eyes immediately, as the methodology set itself apart from a usual lobectomy. I had read Prof. Hiroaki Nomori’s Illustrated Anatomical Segmentectomy for Lung
Cancer twice before my visit, but my perception had only remained at a theoretical stage until
I witnessed Prof. Chen’s procedure onsite, which led me to obtain a deeper understanding of
the methodology. After returning to the Peking University Shenzhen Hospital, I called for a
discussion with Dr. Guangxian Mao and Dr. Yuancai Xie, a deputy chief physician and a chief
physician, who had just learned the surgical method of segmentectomy from Prof. Mingqiang
Kang in Union Hospital of Fujian Medical University. Soon after that, we decided to perform
the thoracoscopic precise segmentectomy with 3D navigation. With the help of Zhenyuan
(Tianjin) Medical Device Technology Co. (MIMICS), the rst seminar on this procedure was
successfully held in September 2018in South China. Up until now, we have successfully held
eight in-person and six online sessions, accumulating invaluable experiences. However, I have
always had a perpetual thought: even though I have been a thoracic surgeon for more than 20
years, my experiences cannot help me shorten the long and strenuous learning curve when
practicing segmentectomy techniques. Can we summarize our experiences and extract the
essences to help more thoracic surgeons shorten the learning curve and master these techniques more easily? Seeing the drawing skills of my graduate student, Dr. Junbin Wang, has
made me more determined to compose the Atlas.
The core of segmentectomy is to determine the resection boundary, which is along the intersegmental veins. Identifying the intersegmental veins helps determine the scope of the operation. As long as the operation is performed within the intersegmental veins with the approach
“From the Shallower to the Deeper,” the blood vessels and bronchi within them can be dissected precisely, avoiding accidental injuries to the surroundings. This methodology is also
known as “Simplied Standard Segmentectomy.” To identify the intersegmental veins, one
must determine the lung segment or subsegment along the safe margin of the nodule and carefully study the adjacent relationships and travel directions among arteries, veins, and bronchi
in the 3D reconstruction drawings.
This procedure technique inherits from the “Wang’s Technique” of Academician Wang Jun
and launches further developments of the “Wave Opening Technique,” “Vessel-Dissected
Inating and Deating Method,” “3D Guided Standard Segmentectomy with Intersegmental
Veins as Anatomical Landmarks,” etc. The book contains individualized 3D reconstruction
drawings of arterial, venous, and bronchial relations, images of intraoperative surgical, and
most importantly, simplied hand drawings that help readers grasp the full range of segmentectomy smoothly.
In fact, the spatial adjacency and branching directions among the arteries, veins, and bronchi vary vastly in each lung segment, making it difcult for surgical operators to mentally
formulate the spatial 3D relationship simply by looking at 2D Chest CTs. However, with the
help of 3D reconstruction software that integrates the spatial relationship among the three
tubes, surgical operators can combine it with the “2.5 D” images seen during surgery (as the
pulling direction of lung during a procedure can change the spatial relationship between the
ix
x
three tubes) to form a closed loop learning curve. This, in turn, increases an operator’s ability
to read 2D Chest CTs for spatial imagery. The book selects 12 examples of segmentectomy as
a mere beginning to guide readers to gain prociency in this technique.
In the process of writing the book, I have received tremendous support from my wife, Yi Li.
Without her support and encouragement, it is hard to imagine how to complete this book in
such a short period of time.
The book was conceived under the careful guidance of Prof. Lijian Zhang from Peking
University Cancer Hospital and obtained the support of all doctors of the Thoracic Surgery
Department at Peking University Shenzhen Hospital during composition. The intraoperative
images and videos included in this book were recorded with high-denition equipment provided by Karl Storz. The surgical video recording process received devoted help from the
operating room nurses, especially Mrs. Che Jia-Ping. The images were carefully organized and
edited by Mrs. Guan-Nan Liu. During the translation process, I received great help from
Andrew Chang, Suen Hon Chi, and Jingjing Liu.
Last but not least, the book received unparalleled support from Yun Chen, President of
Peking university Shenzhen Hospital. Huaigu Tian, Yu Shi etal. also helped a lot during the
publishing process.
With their support and dedication, we make our dream come true.
Due to limited experience, the book leaves much to be desired, and I would appreciate corrections from all readers.
Shenzhen, China JixianLiu
Preface
Contents
1 A Brief History of Thoracoscopic Anatomical Segmentectomy
by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Jixian Liu and Guangxian Mao
2 Nomenclature of Segments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Jixian Liu and Junbin Wang
3 3D Reconstruction of Lung by MIMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Songtao Liu
4 Indications and Technical Details of Segmentectomy for Lung Cancer . . . . . . . . 23
Jixian Liu and Guangxian Mao
5 LS
6 LS
1 + 2
+ LS3 Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Jixian Liu, He Wang, and Xuxing Peng
4 + 5
Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Jixian Liu and Junbin Wang
7 Extended LS3 Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Jixian Liu and Wei Yue
8 RS1 Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Jixian Liu and Xiaoqiang Li
9 Extended RS2 Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Jixian Liu and Xiaoqiang Li
10 RS3 Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Jixian Liu and Lei Yang
11 RS2b + RS3a Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Jixian Liu and Yiwang Ye
12 RS1 + RS2 + RS3c Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . 85
Jixian Liu and Zichun Wei
13 LS6 Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Jixian Liu and Feihu Long
14 RS8a Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Jixian Liu and Xinyu Luan
15 LS9 + LS10 Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Jixian Liu and Xinyu Luan
16 LS10b + c Segmentectomy by 3D Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
Jixian Liu and Dan Ma
xi
Editors and Contributors
About the Editors
Jixian Liu Doctor of Medicine (M.D.), Professor of Peking
University, Chief Surgeon, Doctoral Supervisor, and the
Director of the Thoracic Surgery Department at the Peking
University Shenzhen Hospital.
In 1993, he graduated from Harbin Medical University with
a bachelor’s degree.
In 2006, he graduated from Peking University Health
Science Center with a master’s degree under the supervision of
Professor Bengu Zhang.
In 2011, he received his M.D. from Peking University Health
Science Center, and his supervisor was Academician Jun Wang.
Academic positions:
Member of European Society of Thoracic Surgeons (ESTS);
Director of Lung Nodule Treatment Committee of China Anti-
Cancer Association Rehabilitation Society;
Deputy Director of Esophageal MDT Committee of Guangdong
Chest Disease Society;
Deputy Director of Thoracic Surgery Committee of Shenzhen
Medical Association.
Specialties:
Proposed the “Concept of Simplifying Standard Lung
Segmentectomy” and hosted nine ofine and six online seminars in China, training more than 1000 thoracic surgeons to
undergo segmentectomies with 3D navigation. He is skilled in
single port VATS lobectomy and segmentectomy, minimally
invasive radical esophageal cancer surgery, NUSS, and subxiphoid mediastinal tumor resection. Dr. Liu has published more
than 20 SCI-indexed articles and supervises three undergoing
research projects.
xiii
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