Endoscopic Occlusive Lung Segmentation as an Alternative in the Delimitation of Surgical Margins

Abstract

Introduction: Anatomical segmentectomy is positioned as an alternative in pulmonary nodules and patients with limited respiratory function, requiring precise segmental delimitation to preserve healthy parenchyma.

Objective: To propose the technique of intraoperative segmental pulmonary occlusion using a balloon guided by flexible bronchoscopy, aimed at solving the critical challenge of accurately identifying the pulmonary segment to be resected during segmentectomies by video-assisted thoracic surgery (VATS).

Methods: A descriptive narrative review of the literature (January 2015-March 2025) was conducted in PubMed, Scopus, Web of Science, and SciELO. MeSH terms and keywords were used. From 267 initial references, two reviewers selected 82 articles and analyzed 33 in detail, classifying techniques of color injection, differential ventilation, bronchoscopic navigation, and balloon occlusion.

Development: The technique involves inserting a balloon through the flexible bronchoscope to selectively occlude the segmental bronchus, insufflate oxygen into the target segment, and clearly differentiate it from the collapsed lung. This allows for precise definition of resection margins, reduces air leaks and respiratory dysfunction, and facilitates its use in centers with limited technological resources.

Conclusions: The intraoperative segmental lung occlusion technique shows potential for optimizing results in thoracoscopic segmentectomies by ensuring accurate anatomical delimitation and lung preservation. Although it requires high bronchoscopic skill and can present challenges in complex anatomies, it expands surgical options in small tumors and in patients with compromised function.