Techniques for intraoperative identification and confirmation of segmental bronchus in minimally invasive segmentectomy

In recent years, the early detection rate of lung cancer has increased worldwide mainly due to the implementation of screening programs. On the other hand, minimally invasive segmentectomy has increasingly been performed to treat small-sized lung lesions since the validity of this technique has been fully demonstrated. However, segmentectomy is considered a more challenging procedure than lobectomy based on the complex structure and anatomical variations of the segment. Therefore, accurate identification of the afferent broncho vascular structures is vital to achieve optimal outcomes in segmentectomy. Identifying the segmental bronchus is one of the essential steps of the procedure and constitutes one of the main technical difficulties in segmentectomy. Several methods to distinguish the target bronchus during minimally invasive segmentectomy have been reported. However, each of these methods has its own advantages and limitations and, to date, no consensus exists about which is the best way to intraoperatively recognize the segmental bronchus. Thus, the objective of this review is to determine techniques for identifying and confirming the target bronchus in minimally invasive anatomical segmentectomies. This review article emphasizes the importance of using a flexible approach that combines different methods tailored to specific clinical situations and available resources. The main goal is to improve segmentectomy outcomes, minimize the risk of complications, and safely shorten the duration of these procedures.