A segmentectomy, or segment resection, is a surgical treatment that can be

an option to treat early-stage, non-small cell lung cancer (NSCLC). It involves

the removal of part of one of the lobes of the lung to entirely remove a
cancerous tumor. This procedure is similar to a wedge resection, though it
removes a larger piece of lung tissue.

A segmentectomy may be performed as an alternative to a lobectomy—a

procedure in which a large piece (lobe) is removed from the lung—as long
as the cancer is contained within a small area. You may also be a candidate
for this procedure if you do not have enough lung function to withstand
removing a whole lobe.
The following are the general steps of a posterior segmentectomy of
the right upper lobe:
1. Perform a bronchoscopy prior to the procedure to understand the
segmental anatomy, as not all patients will have a typical
trifurcated right upper lobe.
2. Begin with a posterior dissection. Identify the bronchus and the
take-off of the right upper lobe.
3. Dissect the major fissure and identify the pulmonary artery.
Follow this plane toward the dissection point in step 2. 4. Complete
the division of the major fissure using a stapler. 5. Dissect vascular
structures to the posterior segment. The vein is generally the first
structure to present in the fissure.
6. Dissect and divide the posterior ascending branch of the
pulmonary artery.
7. Dissect and retrieve lymph nodes during the course of the
procedure to optimize the N1 yield.
8. Inspect the bronchus and divide the appropriate posterior
bronchus. Bronchoscopy can be helpful at this point. 9. Identify the
division point within the parenchyma. Traditionally, this is achieved
by gentle ventilation after division of the bronchus, however this
has the disadvantage of reducing working space in the chest. A
more optimal solution, and one which better respects vascular
supply, is some form of perfusion based imaging.
10. Divide the parenchyma using staples that are appropriate for
thicker tissue.