6．区域間同定のための技術

Techniques to Identify Inter-segmental Planes

スリガラス状陰影を呈する早期肺癌や高齢者・高リスク患者の肺癌増加に伴い，区域切除の機会が増えている．中枢寄りに位置する転移性肺腫瘍に対しても区域切除の機会は少なくない．

There are several different approaches to identify inter-segmental planes in segmentectomy. Inflation-deflation lines can be made by inflating the lung after clumping or resecting the target bronchus, or inflate the target bronchus by jet ventilation, direct tubing, or applying a slip-knot. Indocyanine green can be injected intravenously after resecting or clumping the target pulmonary artery to identify the target segment under an infra-red thoracoscope. Indocyanine green can also be injected through a target bronchus. Virtual-assisted lung mapping （VAL-MAP） is a bronchoscopic multispot dye marking technique. Although VAL-MAP was developed to localize small pulmonary nodules, the multiple marks that provide geometric information on the lung enables application of VAL-MAP to segmentectomy, putting more emphasis on resection margins than accurate identification of intersegmental planes. As such, VAL-MAP is particularly useful in extended or complex segmentectomies.

There are advantages and disadvantages in each method. The rapid progress of technology is likely to advance each method further. Taking these into consideration, surgeons need to choose an appropriate technique and possibly combination of these techniques to obtain optimal outcomes in segmentectomy.