Thoracoscopic Pulmonary Sub-Subsegmentectomy Based on Three-Dimensional Images

Thoracoscopic anatomic pulmonary segmentectomy and subsegmentectomy have become sophisticated surgical solutions for complex pulmonary diseases. The rapid development of three-dimensional computed tomographic angiography (3DCTA) has made it possible to provide more refined individualized anatomic details and has consequently enabled sub-subsegmentectomy (SSS). In this study, we report two successful thoracoscopic anatomic SSSs of the left S(1+2)aii and S(3)aii under the guidance of 3DCTA reconstructed images. To the best of our knowledge, these are the first two cases of SSSs ever detailed reported. The nomenclature of subsubsegments is adopted according to the Japanese Committee on the Nomenclature for Bronchial Branching. (C) 2016 by The Society of Thoracic Surgeons