Segmentectomies

Segmentectomy describes a technique whereby part of the lung is excised along its anatomical landmarks based on bronchovascular anatomy. All surgeons dealing with pulmonary resection should master this technique as segmentectomy will contribute in preserving as much healthy lung tissue as possible, especially for the patient with limited pulmonary functional reserve. The indication for segmentectomy has shifted from a procedure to remove a destroyed segment after infection towards a surgical option for patients with very early, peripheral (Stage IA ≤2.0 cm) non-small cell lung cancer (NSCLC) or for patients with limited cardiopulmonary reserve with a favorable sized and located NSCLC without lymph node involvement. Nevertheless, before segmentectomy can become the standard resectional procedure for early NSCLC, we need to await the results of two ongoing randomized controlled trials. In this paper, the authors describe the open technique for segmentectomy via anterior thoracotomy illustrated with figures and videos. With increasing experience, the open technique in the future may be replaced by minimally invasive techniques with video-assisted or robotic-assisted thoracic surgery resulting in shorter hospital stay, lower pulmonary morbidity, and earlier reconvalescence.