How to improve the precision of closed chest sublobar resections

Despite carcinological results awaiting validation, sublobar resections (SLRs) are of increasing interest due to the progressive change in tumour profile and to their lower morbidity when compared to lobectomies. However, this morbidity remains too high in comparison to non-surgical alternatives. Decreasing the complication rate requires greater precision. We present here the different ways to improve the accuracy of the different steps of these interventions: (I) performing these procedures via a closed chest approach; (II) knowing as much as possible about segmental anatomy and studying mapping; (III) performing an intraoperative examination on the intersegmental lymph nodes and on resection margins; (IV) using a preoperative or intraoperative marking method to determine the intersegmental plane (ISP); (V) stapling ISP, an imperfect method but that currently represents the least bad compromise between accuracy and safety.