{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T03:19:34Z","timestamp":1783653574347,"version":"3.55.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":59,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Gen Thorac Cardiovasc Surg Cases"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fissureless lobectomy has been shown to prevent air leaks in patients with fused or incomplete interlobar fissures or emphysema. The technique is also beneficial in advanced lung cancers involving adjacent lobes, where interlobar manipulation is technically difficult. Although this technique is widely used in standard lobectomies, reports on bilobectomy remain scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 57-year-old woman with left-sided tongue cancer (pT2N0M0, Stage II) underwent subtotal glossectomy followed by postoperative concurrent chemoradiotherapy. Eighteen months after the surgery, imaging revealed a mass in the right lower lobe. Bronchoscopy confirmed squamous cell carcinoma, and the patient was referred to our department with suspected pulmonary metastasis.<\/jats:p>\n                    <jats:p>Over the 3\u00a0weeks following initial presentation, the lung tumor enlarged rapidly. The tumor was centered in the lower lobe with invasion of the middle and upper lobes, and the distal lung parenchyma was complicated by obstructive pneumonia. Although antibiotics were administered, the fever and inflammatory markers persisted; thus, we decided to proceed with surgery for infection control. Due to the presence of incomplete lung fissure and the lower lobe tumor invading the other lobes, pneumonectomy was the initial option. However, to preserve lung capacity, we decided to perform a fissure-last right middle and lower bilobectomy with division of the interlobar pulmonary artery prior to resection of the bronchus. The patient was discharged 16\u00a0days after surgery without complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We report a case of bilobectomy using a modified fissureless technique and describe the technical details of how we dissect the pulmonary artery prior to resection of the bronchus. Being familiar with the fissureless bilobectomy technique is an important option for avoiding right pneumonectomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s44215-026-00262-5","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T06:17:17Z","timestamp":1778566637000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Right middle and lower bilobectomy using a modified fissureless technique: a case report"],"prefix":"10.1186","volume":"5","author":[{"given":"Eiji","family":"Narusawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiteru","family":"Nagashima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoichi","family":"Ohtaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natsuko","family":"Kawatani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Yazawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryohei","family":"Yoshikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masazumi","family":"Koike","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Shirabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6218-9396","authenticated-orcid":false,"given":"Seshiru","family":"Nakazawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"262_CR1","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1016\/j.jtcvs.2009.07.023","volume":"139","author":"T Ng","year":"2010","unstructured":"Ng T, Ryder BA, Machan JT, Cioffi WG. Decreasing the incidence of prolonged air leak after right upper lobectomy with the anterior fissureless technique. J Thorac Cardiovasc Surg. 2010;139:1007\u201311.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"262_CR2","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1093\/icvts\/ivx061","volume":"25","author":"S Li","year":"2017","unstructured":"Li S, Lv W, Zhou K, Che G. Does the fissureless technique decrease the incidence of prolonged air leak after pulmonary lobectomy? Interact Cardiovasc Thorac Surg. 2017;25(1):122\u20134.","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"262_CR3","first-page":"2025","volume":"30","author":"H Tao","year":"2025","unstructured":"Tao H. A robotic fissureless en bloc resection of left S6 and S1+2a+b for lung cancer located at an incomplete fissure. Multimed Man Cardiothorac Surg. 2025;30:2025.","journal-title":"Multimed Man Cardiothorac Surg"},{"key":"262_CR4","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1093\/ejcts\/ezv455","volume":"50","author":"D Stamenovic","year":"2016","unstructured":"Stamenovic D, Bostanci K, Messerschmidt A, Jahn T, Schneider T. Fissure-less fissure-last video-assisted thoracoscopic lobectomy for all lung lobes: a better alternative to decrease the incidence of prolonged air leak? Eur J Cardiothorac Surg. 2016;50:118\u201323.","journal-title":"Eur J Cardiothorac Surg"},{"key":"262_CR5","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1093\/icvts\/ivv048","volume":"21","author":"H Decaluwe","year":"2015","unstructured":"Decaluwe H, Sokolow Y, Deryck F, Stanzi A, Depypere L, Moons J, et al. Thoracoscopic tunnel technique for anatomical lung resections: a \u201cfissure first, hilum last\u201d approach with staplers in the fissureless patient. Interact Cardiovasc Thorac Surg. 2015;21:2\u20137.","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"262_CR6","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1186\/s40792-021-01308-2","volume":"7","author":"S Uchiyama","year":"2021","unstructured":"Uchiyama S, Iizuka S, Nakamura T. Fissure-first bilobectomy of a giant lung abscess combined with a squamous cell carcinoma via a minimally invasive open surgery. Surg Case Rep. 2021;7:224.","journal-title":"Surg Case Rep"},{"key":"262_CR7","first-page":"2024","volume":"5","author":"H Saad","year":"2024","unstructured":"Saad H, Asemota N, Alqudah O, Asqalan A, Fuentes-Warr J, Wilson S, et al. Robotic intrapericardial bilobectomy with stapler on the atrium and pericardial reconstruction. Multimed Man Cardiothorac Surg. 2024;5:2024.","journal-title":"Multimed Man Cardiothorac Surg"},{"key":"262_CR8","doi-asserted-by":"publisher","first-page":"19","DOI":"10.21037\/asj-21-109","volume":"3","author":"Y Yutaka","year":"2023","unstructured":"Yutaka Y, Nagata S, Sugimoto A, Date H. Successful right lower bilobectomy for endobronchial carcinosarcoma rapidly occluding the trachea: a case report. AME Surg J. 2023;3:19.","journal-title":"AME Surg J"},{"key":"262_CR9","doi-asserted-by":"publisher","first-page":"4536","DOI":"10.21037\/jtd-2024-2204","volume":"17","author":"P Skrzypczak","year":"2025","unstructured":"Skrzypczak P, Kasprzyk M, Kami\u0144ski M, Gabryel P, Ochman M, Chwalba A, et al. Key risk factors for mortality after pneumonectomy for lung cancer: insights from a large single-center cohort study. J Thorac Dis. 2025;17:4536\u201349.","journal-title":"J Thorac Dis"},{"key":"262_CR10","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.lungcan.2007.07.008","volume":"58","author":"IK Ilonen","year":"2007","unstructured":"Ilonen IK, R\u00e4s\u00e4nen JV, Sihvo EI, Knuuttila A, Sovij\u00e4rvi AR, Sintonen H, et al. Pneumonectomy: post-operative quality of life and lung function. Lung Cancer. 2007;58:397\u2013402.","journal-title":"Lung Cancer"},{"key":"262_CR11","doi-asserted-by":"crossref","unstructured":"Mochizuki T, Okumura S, Ishii G, et al. Surgical resection for oral tongue cancer pulmonary metastases. Interact Cardiovasc Thorac Surg. 2010;11:56\u20139.","DOI":"10.1510\/icvts.2009.226399"}],"container-title":["General Thoracic and Cardiovascular Surgery Cases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s44215-026-00262-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44215-026-00262-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44215-026-00262-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T03:09:25Z","timestamp":1783652965000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s44215-026-00262-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["262"],"URL":"https:\/\/doi.org\/10.1186\/s44215-026-00262-5","relation":{},"ISSN":["2731-6203"],"issn-type":[{"value":"2731-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]},"assertion":[{"value":"18 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This work does not require ethical considerations or approval. Informed consent to participate in this study was obtained from the patient.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for the publication of the case details and accompanying images was obtained from the patient.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"26"}}