J.Jpn. Surg. Soc.. 127(1): 52-57, 2026

---

Feature topic

TIPS ON RATS PULMONARY SEGMENTECTOMY FOR SMALL LUNG CANCER

RATS allows for precise operation using forceps manipulation with articulation and a 3D thoracoscopic view, making it useful for pulmonary segmentectomy. However, it is difficult to obtain adequate surgical margins for small lung cancers. We have established RATS pulmonary segmentectomy as a standardized method for small lung cancers through various innovations.
Preoperative 3D-CT is used to identify anatomic differences in each case. We simulate a surgical procedure that minimizes the resection area while maintaining tumor margins, a process called “tailor-made segmentectomy.” To perform this procedure, the technique of resecting all segments and subsegments is required. If the tumor is resectable as a single segment, a single segmentectomy is performed. If adjacent lesions are present, a combined subsegmental resection is performed to ensure margins. This procedure can be performed with the surgeon’s bimanual control and the assistant’s coordinated operation. Furthermore, accurate segmentectomy requires dissecting the central intersegmental plane to expose the anatomy. A method called the “peripheral stump guiding method” is useful for resection at the subsegmental level. When using Sure Form, resection of the peripheral intersegmental plane is performed using resection lines from multiple directions to minimize lung deformation. We believe that RATS pulmonary segmentectomy can be standardized using these techniques.

---

---

To read the PDF file you will need Adobe Reader installed on your computer.