Anatomical variations and pitfalls to know during thoracoscopic segmentectomies

The rate of sublobar resection (SLR) for early-stage non-small cell lung carcinoma (NSCLC) is increasing, mainly because of a growing rate of early-stage lung carcinomas and ground-glass opacities. More and more SLRs are now performed by a thoracoscopic, a video-assisted or a robotically-assisted approach. Although surgeons are performing pulmonary segmentectomies for years, they need a better understanding of anatomy when using a closed chest approach, because vision is more limited and they cannot stretch and expose the parenchyma and broncho-vascular elements. In this article, we will describe most of the significant anatomical variations we have encountered during a consecutive series of 390 full thoracoscopic segmentectomies, either at surgery or preoperatively by studying the 3-dimensional (3D) modelisation.