Common and Uncommon Variations of Pulmonary Venous Drainage in Patients Undergoing Thoracoscopic Lobectomy

Amore, Dario; Casazza, Dino; Imitazione, Pasquale; Curcio, Carlo

doi:10.1055/s-0039-1684000

Cited by 2 publications

(1 citation statement)

References 11 publications

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“…The current scientific literature documents several imaging findings and systematic overview of pulmonary vein abnormalities provided by radiologists for a correct recognition of aberrant vessels and a more precise identification of pulmonary nodules or intersegmental lymph nodes near to vascular structures. In the last decade, also in other fields such as the thoracic surgery, many authors have reported a wide spectrum of venous pulmonary anomalies identified preoperatively or intraoperatively in order to make lung major resections safer during video‐assisted thoracoscopic surgery (VATS) where a short exposition of the pulmonary hilum can lead to mistakes due to incorrect identification of anatomical variations [1–3]. This report shows that, in some instances, pulmonary vascular anomalies require not only a meticulous hilar dissection, but also a different surgical strategy to achieve safe surgical resections.…”

Section: Introductionmentioning

confidence: 99%

Drainage of middle lobe vein into anomalous right lower lobe vein: management during thoracoscopic lobectomy

Amore

Saglia

Casazza

et al. 2020

Respirology Case Reports

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Variations in pulmonary venous anatomy should not be underestimated by thoracic surgeons prior to or during major lung resections in order to avoid serious surgical complications. Here, we report a case of middle lobe vein draining into a right inferior lobar vein formed by two anomalous trunks lying on the superior surface of the common basal bronchus: in such instance, to avoid compromising the middle lobe vein drainage during a thoracoscopic right lower lobectomy, the two main tributaries of the lower lobe vein were individually identified and dissected peripherally from the anterior aspect after division of the major fissure. A careful hilar dissection and a precise surgical strategy can help surgeons perform correct procedures in presence of pulmonary vascular anomalies.

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Section: Introductionmentioning

confidence: 99%

Drainage of middle lobe vein into anomalous right lower lobe vein: management during thoracoscopic lobectomy

Amore

Saglia

Casazza

et al. 2020

Respirology Case Reports

Self Cite

View full text Add to dashboard Cite

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Preoperative 3D-CT bronchography and angiography facilitates single-direction uniportal thoracoscopic anatomic lobectomy

Zhang

Liu

et al. 2019

Ann. Transl. Med.

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Background: Competency in video-assisted thoracoscopic surgery (VATS) lobectomy is estimated to be reached after 50 cases. Preoperative identification of individualized pulmonary vascular drainage is essential for the safe and fluent performance of single-direction uniportal VATS (UVATS) anatomic lobectomy.Digital anatomy models established by three-dimensional computed tomography bronchography and angiography (3D-CTBA) is therefore utilized to accumulate variations of the right upper lobe (RUL) veins, as right upper lobectomy is considered to be the most complicated and challenging procedure. This study aims to investigate the perioperative outcomes and learning curve of single-direction UVATS RUL lobectomy assisted with 3D-CTBA. Methods:The patients who underwent single-direction intercostal UVATS anatomic RUL lobectomy after 3D-CTBA simulation by the same surgeon at Xuzhou Central Hospital between January 2017 and April 2019 were retrospectively reviewed (3D-CTBA group), and consisted of 99 males and 54 females, with a mean age of 61.6 years, with the variations of the RUL vein being assessed preoperatively. They were further divided into group A (30 cases), B (30 cases), C (30 cases), and D (63 cases), in accordance with the order of surgery. Meanwhile, the first 35 cases of single-direction UVATS RUL lobectomy by another experienced surgeon (after the learning curve of this procedure) who did not use 3D-CTBA was enrolled as a control group. The operation time, intraoperative blood loss, stations and numbers of harvested lymph nodes, the incidence of conversion to multiport VATS or thoracotomy, thoracic tube retention for drainage, complications defined under the Clavien-Dindo system, pain score, and postoperative hospital stay were analyzed. The previous surgical experience of the two surgeons was also evaluated.Results: A significant difference was evident among the 5 groups in terms of age, smoking history, the proportion of neoadjuvant chemotherapy, and T staging of the tumors (P<0.05, respectively). As for the 3D-CTBA group, a total of 29 cases (19.0%) of anomalous RUL posterior segmental pulmonary vein (PV) (V 2 ) drainage were recorded, while the other 124 patients indicated the central type (V2a. Cent.). Of the uncommon RUL V 2 , they could be further classified into 4 types [V2a. Post. (5/153, 3.3%), VX2a. Ant.(17/153, 11.1%), VXX2a. Ant. (3/153, 2.0%), and nonspecific complicated (4/153, 2.6%)]. Single-direction UVATS lobectomy was performed in every patient successfully. No perioperative mortality, major bleeding, conversion to thoracotomy, the addition of incisions, or 30-day unplanned readmission was recorded. One patient in group B reported an injury of a bronchial artery. All cases had an R0 resection. The operation time of group A (109.8±25.4 min) was significantly longer than that of group B (79.7±11.1 min), C (77.0±12.1 min), D (69.3±16.0 min), and the control (86.1±17.9 min, P<0.001 respectively). Moreover, the operation time of the patients in group B, C, and D was slightly shorter than th...

show abstract

Common and Uncommon Variations of Pulmonary Venous Drainage in Patients Undergoing Thoracoscopic Lobectomy

Cited by 2 publications

References 11 publications

Drainage of middle lobe vein into anomalous right lower lobe vein: management during thoracoscopic lobectomy

Drainage of middle lobe vein into anomalous right lower lobe vein: management during thoracoscopic lobectomy

Preoperative 3D-CT bronchography and angiography facilitates single-direction uniportal thoracoscopic anatomic lobectomy

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