Abstract
Anatomical VATS segentectomy of the left upper division of the lung was performed as positive limited surgery in a 75-year-old woman with small peripheral adenocarcinoma in left S1+2. The upper division and lingular segment were separated in accordance with anatomical structures such as the location of the pulmonary vein, using an Ultrasonically Activated Scalpel (Harmonic Scalpel). Fibrin glue and PGA felt were used to treat cut surfaces of the residual lung. No air leakage was observed immediately postoperatively, so the chest drainage catheter was renived on postoperative day (POD) 1, and she was discharged from hospital on POD 7. Pathological examination revealed a 12×10×7mm Noguchi Type B adenocarcinoma. The pathological classification was T1N0M0, stage IA. Preservation of the respiratory muscles was achieved using VATS, and the detachmentof the segments using the Ultrasonically Activated Scalpel, without a surgical stapler, resulted in good expansion and preservation of the residual lung volume, This operative method prevented postoperative air leakage and contributed to improved postoperative QOL, and appears to be useful as a limited surgery for small peripheral lung cancer cases.
