Artery-leading segmentectomy: a novel “AIDVB” (Artery-priority, Inflation/deflation, Vein/Bronchus): a cross-sectional study

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INTRODUCTION: Recent clinical trials (including JCOG0802 and GLB140503) have demonstrated favorable outcomes for sublobar resection in small lung nodules, highlighting the importance of precise anatomical segmentectomy. However, accurate identification of intersegmental planes remains technically challenging. We developed the AIDVB (Artery-priority, Inflation/deflation, Vein/Bronchus) procedure to improve surgical precision. METHODS: Between January 2019 and December 2021, 1485 patients underwent anatomical segmentectomy at our institution. Of these, 1342 patients underwent traditional anatomical segmentectomy, while 143 patients underwent the AIDVB procedure. Preoperative CT images were reconstructed to assess anatomical variations, and three-dimensional computed tomography bronchography and angiography were utilized to identify the dominant pulmonary artery and intrasegmental veins. Clinical characteristics, surgical parameters, and postoperative inflammatory markers were collected and compared between the two groups. RESULTS: The study revealed a distinct hierarchical pattern in plane formation quality: intrasegmental venous plane < target segmental arterial plane < intrasegmental + intersegmental venous plane. The intersegmental planes formed after arterial dissection demonstrated high concordance with natural anatomical boundaries, confirming the importance of the artery-priority approach in precise intersegmental plane identification. Compared to the traditional group, the AIDVB group showed significantly shorter operative times (87.38 ± 43.23 vs 101.09 ± 42.99 minutes, P = 0.001) and lower required inflation pressures (22.8 ± 6.2 vs 37.8 ± 7.9 cmH2O, P = 0.001). The reduced inflation pressure helped minimize alveolar injury, as evidenced by lower postoperative inflammatory markers in the AIDVB group: IL-6 (24.28 ± 16.32 vs 59.89 ± 61.96 pg/mL, P = 0.021) and SP-D (4647.21 ± 2020.05 vs 7103.66 ± 2814.72 pg/mL, P = 0.003). Additionally, the AIDVB group demonstrated shorter drainage duration (3 ± 0.93 vs 3.27 ± 1.45 days, P = 0.031) and hospital stay (4 ± 0.91 vs 4.25 ± 1.47 days, P = 0.003), indicating faster postoperative recovery. CONCLUSION: The AIDVB procedure achieves more precise intersegmental plane identification through artery-priority approach, offering advantages of shorter operative time, lower inflation pressure, and faster postoperative recovery, while reducing specific inflammatory markers. Its systematic approach and minimal additional equipment requirements facilitate widespread clinical adoption.

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