Journal of thoracic disease · 2025
The role of the stapled interlobar fissure position for intraoperative detection and postoperative diagnosis of middle lobe torsion after right upper lobectomy.
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Ohtaka Kazuto, Ohtake Setsuyuki, Fujiwara-Kuroda Aki, Narita Sho, Otsuka Shinya, Yamasaki Hiroshi, Sasaki Akihiro, Shiiya Haruhiko, Ujiie Hideki, Aragaki Masato, Kato Tatsuya
Аннотация
BACKGROUND: Lung torsion is caused by the lung twisting around the hilum, leading to severe conditions with a high mortality rate. We evaluated the usefulness of the stapled interlobar fissure (SIF) position for intraoperative detection and postoperative early diagnosis of middle lobe (ML) torsion after right upper lobectomy (RUL).
METHODS: This retrospective study included 271 patients who underwent RUL at the Hokkaido University Hospital or Obihiro Kosei General Hospital. We assessed the SIF position between the upper lobe and ML on postoperative computed tomography (CT) scans and surgical videos, and correlated it with postoperative abnormalities in the ML, such as atelectasis or rotation of the bronchus and pulmonary vessels.
RESULTS: On postoperative CT scans, the SIF position was on the interlobar side in 24 (96.0%) of 25 patients with abnormal findings in the ML, and on the mediastinal side in 224 (91.1%) of 246 patients without abnormalities (P<0.001). The sensitivity and specificity were 96.0% and 91.1%, respectively. At the end of the surgery, the SIF position was on the interlobar side in 10 (90.9%) of 11 patients with abnormal findings in the ML, and on the mediastinal side in 53 (86.9%) of 61 patients without abnormalities (P<0.001). The sensitivity and specificity were 90.9% and 86.9%, respectively.
CONCLUSIONS: The SIF position observed at the end of the surgery and on postoperative CT scans was significantly associated with postoperative ML abnormalities. Therefore, observing SIF positions intraoperatively and on postoperative CT may aid in intraoperative detection and postoperative diagnosis of ML torsion after RUL.
METHODS: This retrospective study included 271 patients who underwent RUL at the Hokkaido University Hospital or Obihiro Kosei General Hospital. We assessed the SIF position between the upper lobe and ML on postoperative computed tomography (CT) scans and surgical videos, and correlated it with postoperative abnormalities in the ML, such as atelectasis or rotation of the bronchus and pulmonary vessels.
RESULTS: On postoperative CT scans, the SIF position was on the interlobar side in 24 (96.0%) of 25 patients with abnormal findings in the ML, and on the mediastinal side in 224 (91.1%) of 246 patients without abnormalities (P<0.001). The sensitivity and specificity were 96.0% and 91.1%, respectively. At the end of the surgery, the SIF position was on the interlobar side in 10 (90.9%) of 11 patients with abnormal findings in the ML, and on the mediastinal side in 53 (86.9%) of 61 patients without abnormalities (P<0.001). The sensitivity and specificity were 90.9% and 86.9%, respectively.
CONCLUSIONS: The SIF position observed at the end of the surgery and on postoperative CT scans was significantly associated with postoperative ML abnormalities. Therefore, observing SIF positions intraoperatively and on postoperative CT may aid in intraoperative detection and postoperative diagnosis of ML torsion after RUL.