An alternate name for the operation is, therefore, lingular sparing left upper lobectomy (7). These can be clearly isolated from the superior and inferior lingular segments, as the vasculature and airways are anatomically distinct from each other and can be clearly identified with surgical dissection. The left apical tri-segments are the apico-posterior and the anterior segments of the upper lobe. The left upper lobe has anatomically well-defined segments with a clear division of the hilar structures from the apical and lingular segments, allowing for an anatomical resection. A clear and detailed knowledge of segmental lung anatomy and advanced thoracoscopic skills are required to perform it. Thoracoscopic segmentectomy can be defined as an anatomical resection of a segment or segments of the lung with individual dissection, isolation, and transection of the vein, artery, and bronchus to the segment/segments using the thoracoscope (camera and monitor) for visualization, and dissection of structures with no rib-spreading (6). The first description of thoracoscopic segmentectomy in an animal model was reported in 1997 (5).
It was abandoned after Ginsberg demonstrated the superiority of lobectomy over sublobar resection in 1995 (3), but has returned as a lung cancer operation in recent years (4). Segmentectomy was first described by Churchill and Belsey for bronchiectasis in 1939 (2). Typically a segment of the lung contributes 5% of the overall lung function, allowing for an improved postoperative FEV1 as compared to a lobectomy (1). Increasing experience with thoracoscopic lobectomy has created an interest in performing anatomical segmentectomy using the thoracoscope, as it combines the benefits of lung conservation with avoidance of a thoracotomy.
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