Dataset Information

Clinical significance of the diverse interlobar veins hidden in the upper oblique fissure.

ABSTRACT:

Background

The interlobar veins hidden in the upper oblique fissure (UOF) of the right lung are usually mismanaged cursorily according to the target lobe, which results in accidental injury of the interlobar veins and complications. The detailed classification of interlobar veins based on surgical anatomical analysis is of great clinical significance.

Methods

Three-dimensional computed tomography bronchography and angiography (3D-CTBA) reconstructed images of 398 patients from January 2019 to June 2020 were retrospectively analyzed. The interlobar veins in the UOF were observed and classified according to their morphology and distribution. The classification model was further validated in 153 patients who underwent surgery involving dissection of the UOF, and related surgical results were analyzed.

Results

The distribution of interlobar veins was diverse, and the general morphology could be divided into 2 main categories and 30 subtypes in the 3D-CTBA images of the 398 patients. Analysis of the 153 patients' surgical data showed that 60 patients suffered from interlobar vein injury. Interlobar veins hidden in an incomplete UOF were the most susceptible to accidental damage (χ²=12.856, P=0.020). A receiver operating characteristic (ROC) curve analysis showed that an interlobar vein diameter larger than 2.4 mm for the oblique fissure interlobar vein type or less than 2 mm for the mediastinal interlobar vein type was associated with a higher risk of injuries (P<0.001).

Conclusions

The diversity of interlobar veins and the completeness of the UOF were noteworthy risk factors in surgery involving dissection of the UOF.

SUBMITTER: Xu X

PROVIDER: S-EPMC8848423 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Clinical significance of the diverse interlobar veins hidden in the upper oblique fissure.

Xu Xinfeng X Wang Jun J Liu Qiang Q Wen Wei W Xu Hai H Zhang Wei W Zhu Quan Q Chen Yijiang Y Chen Liang L

Annals of translational medicine 20220101 2

<h4>Background</h4>The interlobar veins hidden in the upper oblique fissure (UOF) of the right lung are usually mismanaged cursorily according to the target lobe, which results in accidental injury of the interlobar veins and complications. The detailed classification of interlobar veins based on surgical anatomical analysis is of great clinical significance.<h4>Methods</h4>Three-dimensional computed tomography bronchography and angiography (3D-CTBA) reconstructed images of 398 patients from Jan ...[more]

PMID: 35282038

Similar Datasets

Project description:BackgroundThe interlobar bronchovascular structures hidden in the incomplete interlobar fissures (IFs) are often inadvertently transected during pulmonary resections, which could inevitably lead to accidental injury and potentially compromise the function of the preserved area. A thorough examination of the anatomical distribution of translobar bronchi, arteries, and veins holds significant clinical importance.MethodsThree-dimensional computed tomography bronchography and angiography (3D-CTBA) data from patients who underwent pulmonary resection between December 2018 and November 2019 were retrospectively analyzed. The translobar bronchi, arteries, and veins were categorized based on their origin and distribution. Surgical results of patients who underwent surgery involving translobar structures were further reviewed.ResultsAmong the 310 enrolled patients, incomplete IFs (IIFs) were most frequently observed in horizontal fissures (68.7%), followed by right upper oblique fissures (42.3%), left lower oblique fissures (32.6%), left upper oblique fissures (12.9%), and right lower oblique fissures (11.0%). The incidence of bronchovascular structures was significantly higher in IIFs than in complete IFs (CIFs; 85.5% vs. 5.2%, χ2=1,021.1, P<0.001). A total of three subtypes of translobar bronchi, five subtypes of translobar arteries, and 14 subtypes of translobar veins were identified. Primary subtypes of translobar arteries (frequency >5%) included the left A4/5 (18.7%) that branched from A7/8/7+8 and the common trunk of right Asc.A2+A6 (6.1%). Primary subtypes of translobar veins (frequency >5%) included the right V2 draining into inferior pulmonary vein (IPV) (5.8%), the interlobar V3b (58.4%) within horizontal fissures, the right V4/5 draining into V2/3 (26.1%), the left V4/5 draining into IPV (7.4%), the right V6 draining into V2 (38.4%), and the common trunk of left IPV and superior pulmonary vein (SPV; 9.4%). Moreover, 12.0% of translobar arteries and 75.0% of translobar veins were mistransected during anatomical pulmonary resection, resulting in gas-exchanging dysfunction in the preserved territory.ConclusionsTranslobar bronchovascular structures exhibited a high incidence and were more commonly present in IIFs. Surgeons should pay increased attention to these structures to prevent accidental injuries during anatomical pulmonary resection.

Project description:ObjectivesThis study aimed to review the safety of a reusable sealing instrument, BiClamp(®), as an alternative to the mechanical stapler for interlobar fissure division in pulmonary lobectomy.MethodsA retrospective review was conducted of 95 patients who underwent pulmonary lobectomy performed by a single surgeon between November 2005 and March 2010. The patients were divided into two groups according to the period before and after introduction of the BiClamp(®): 29 patients who underwent fissure division with staples only (staple group) and 66 patients who underwent the same procedure mainly with the instrument (BiClamp(®) group).ResultsThere were 60 (63.2%) male and 35 (36.8%) female patients, with a mean ± SD age of 67.5 ± 10.8 years. Comparison of the characteristics of the two groups revealed that the BiClamp(®) group included significantly more cases of lobectomy by video-assisted thoracic surgery and far fewer completely lobulated lungs; 6 of 66 patients (9.1%) compared with 9 of 29 (31.0%) of the staple group. Except for 18 patients who underwent division using staples owing to thick parenchyma of the interlobar fissure, we attempted to divide the fissure of 42 patients in the BiClamp(®) group. Solo use of the BiClamp(®) was possible for 25 of 60 patients (41.7%) with an incomplete fissure. Eight patients (13.3%) needed one staple cartridge in combination with BiClamp(®), five (8.3%) needed two cartridges and four (6.7%) patients needed three (combined use). In most cases, except for right upper or middle lobectomy, the division of the interlobar fissure could be performed by sole use of the BiClamp(®). Incidence rates of prolonged air leakage and pneumonia were not significantly different between the two groups (respectively, 6.9 and 3.4% in the staple group vs 10.6 and 9.1% in the BiClamp(®) group).ConclusionsThe study results demonstrate that the division of the interlobar fissure in pulmonary lobectomy with BiClamp(®) is safe and feasible in most cases. While the results point out the limitation that division of the right upper or middle lobe may still be a challenge, they show the potential benefit of staple reduction. Less use of staples results in reduced medical costs and carbon dioxide emission, contributing to 'ecosurgery', which ultimately conserves the global environment.

Project description:BackgroundThoracoscopic posterior and/ or lateral basal segment resection is a major difficult segmentectomy for thoracic surgeons, because of its high surgical difficulty and high incidence of postoperative complications. Here we describe the surgical procedure and techniques of the transpulmonary ligament approach and/or interlobar fissure approach for the thoracoscopic posterior and/or lateral basal segment resection.MethodsThe clinical data of 31 patients who underwent thoracoscopic posterior and/or lateral basal segment resection from January 2020 to June 2022 were included. All patients underwent posterior and/or lateral basal segment resection via the inferior pulmonary ligament and/or interlobar fissure approach. Follow-up was continued to September 2022.ResultsAll patients including 7 males and 24 females, with a median age of 51 [31-62] years, completed the operation successfully. One patient was converted to lobectomy due to insufficient margins intraoperatively. Two patients were treated using the interlobar fissure approach, 25 patients were treated via the inferior pulmonary ligament approach, and four patients were treated by employing both methods. Also, 20 patients had a single lesion and 1 patient had two lesions. Eleven patients underwent surgical resections on other lesions when posterior and/or lateral basal segment lesions resected. The median operation time was 120 [50-290] minutes, the median intraoperative blood loss was 50 [10-100] mL, the median postoperative drainage time was 4 [2-10] days, and the median postoperative hospital stay was 4 [2-13] days. There was no perioperative death. Postoperative complications included five cases of persistent air leakage longer than 5 days (7, 7, 8, 9, and 10 days), and one patient developed a pulmonary infection and abnormal liver function after the operation. The median maximum diameter of the lesion was 0.8 [0.2-1.5] cm, lymph nodes were resected in a median of 8 [4-15] case.ConclusionsThe approach of the inferior pulmonary ligament to resect posterior and/or the lateral basal segment can optimize the surgical procedure. The surgical trauma and postoperative complications are reduced, which is worthy of popularization and application.

Dataset Information

Clinical significance of the diverse interlobar veins hidden in the upper oblique fissure.

Background

Methods

Results

Conclusions

Publications

Clinical significance of the diverse interlobar veins hidden in the upper oblique fissure.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets