ArticleJournal of visualized surgery2025
Preoperative simulation of uniportal thoracoscopic pulmonary segmentectomy achieves equivalent accuracy of surgical resection margins for palpable and impalpable tumors.
Article in Journal of visualized surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Impalpable tumors are often encountered during thoracoscopic pulmonary segmentectomy, particularly with the uniportal approach, which limits localization by palpation. This study aimed to compare the accuracy of surgical resection margins obtained through preoperative simulation for uniportal thoracoscopic pulmonary segmentectomy between palpable and impalpable tumors. Methods: From February 2021 to November 2024, preoperative simulation was conducted for 192 patients to calculate surgical margins. Among them, 95 underwent the uniportal thoracoscopic approach. After excluding two patients due to missing data, they were categorized into palpable (n=53) and impalpable (n=40) tumor groups. Patient characteristics and perioperative outcomes, including the correlation between simulation and pathological margins, were compared between groups. The Mann-Whitney Results: The impalpable tumor group had significantly older patients (P=0.02), a higher proportion of females (P=0.03), better forced expiratory volume in one second % (P=0.02), and smaller radiographic tumor sizes (P=0.02). Intentional segmentectomy was more frequent in this group (P=0.008), while the proportion of complicated segmentectomies was similar (P=0.08). Pathological margins were significantly longer in the impalpable tumor group (P=0.04), while other perioperative outcomes were statistically comparable. The median discrepancies between simulation and pathological margins were 6 mm [interquartile range (IQR), 3-9 mm] in the palpable group and 6 mm (IQR, 4-8 mm) in the impalpable group, with no significant difference (P>0.99). Simulation margins strongly correlated with pathological margins in all cases (all patients: r=0.626, P<0.001; palpable: r=0.679, P<0.001; impalpable: r=0.668, P<0.001). Conclusions: Preoperative simulation using infrared thoracoscopic observation with intravenous ICG ensures accurate surgical margins, even for impalpable tumors, during uniportal thoracoscopic pulmonary segmentectomy.
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