Intraoperative assessment of pulmonary fissure morphology in a large surgical series: implications for operative strategy.
GENERAL THORACIC AND CARDIOVASCULAR SURGERY, cilt.1, sa.1, ss.1-7, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 1 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s11748-026-02352-1
- Dergi Adı: GENERAL THORACIC AND CARDIOVASCULAR SURGERY
- Derginin Tarandığı İndeksler: Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Scopus, Science Citation Index Expanded (SCI-EXPANDED), EMBASE, MEDLINE
- Sayfa Sayıları: ss.1-7
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Bursa Uludağ Üniversitesi Adresli: Evet
Özet
Abstract Objective The widespread adoption of minimally invasive thoracic surgery necessitates precise anatomical knowledge; however, pulmonary morphology frequently deviates from textbook descriptions. We systematically investigated in vivo fissural variations and their relationships with vascular branching to guide contemporary operative strategies. Methods We conducted a retrospective observational study of 209 patients who underwent anatomical lung resection (128 right sided, 81 left-sided) with meticulous intraoperative exploration between 2002 and 2020. Fissural integrity was assessed using an adapted Craig classification and correlated with pulmonary artery branching patterns and patient demographics. Results Anatomical variations were significantly more prevalent in the left lung (77.0%) than in the right lung (36.7%). Complete fissures were anatomically rare; the major fissure was incomplete in 80.5% of right lungs and 66.7% of left lungs. Furthermore, the right minor fissure was incomplete in 60.2% of cases. A significant correlation was identified between right major fissure com pleteness and superior segmental artery (A6) branching patterns (p = 0.007). Specifically, an incomplete right major fissure was uniformly associated with a single A6 branch (100%), whereas complete fissures demonstrated a single branch in 88.0% of cases and a double-branch pattern in 12.0%. Conclusion Incomplete pulmonary fissures constitute the predominant anatomical norm rather than an anomaly. This high preva lence, coupled with complex vascular associations, undermines reliance on standard anatomical templates. Consequently, indi vidualized operative planning—utilizing tailored approaches such as fissureless lobectomy techniques and advanced preoperative imaging—is imperative to mitigate complications.