VATS right posterior segmentectomy with anomalous bronchi and pulmonary vessels: a case report and literature review

Abstract

Background Anatomic variation may increase the difficulty and risk of anatomic segmentectomy. The preoperative three-dimensional computed tomography bronchography and angiography (3D-CTBA) can provide a detailed model of the segmental structure, and contribute to precise and safe segmentectomy. Case presentation This is a case of anomalous bronchi and pulmonary vessels in the right upper posterior segment (RS2). Under the guidance of 3D-CTBA, anatomic RS2 segmentectomy was performed accurately and safely. The postoperative condition was uneventful. Conclusions This rare case highlights the importance of 3D-CTBA to guild accurate segmentectomy with anatomic variation.

Clinical application of VATS combined with 3D-CTBA in anatomical basal segmentectomy

“…All 42 patients underwent thoracoscopic basal segmentectomy, including 26 cases of simple basal segmentectomy and 16 cases of combined basal segmentectomy (the nodule located between the two basal segments). The median operation time was 125 (90-176) min, the median intraoperative blood loss was 15 (10-50) mL, the median postoperative thoracic drainage time was 3 (2-17) days, and the median postoperative hospital stay was 5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) days. The median number of resected lymph nodes was 6 (5-8).…”

“…However, owing to the complex anatomical structure of the lung, it is difficult to identify the segmental arteries, veins, and bronchi near the segmental hilum, especially in the case of anatomical variation. Surgeons often rely on their experience to transection blood vessels and segmental bronchi; however, incorrect transection of the bronchus will lead to atelectasis, and incorrect transection of the vein will lead to inaccurate intersegmental plane, resulting in poor surgical effect ( 4 ). Three-dimensional computed tomography-bronchography and angiography (3D-CTBA) technology has the advantage of clearly displaying the anatomical structure of bronchi, pulmonary arteries, and veins through 3D images, which allows determination of congenital variation, helps doctors accurately locate lesions before surgery, increases the chance of accurate surgical resection, and reduces operation errors and tissue damage during surgery ( 5 , 6 ).…”

Clinical Efficacy of Thoracoscopic Surgery with the da Vinci Surgical System versus Video-Assisted Thoracoscopic Surgery for Lung Cancer

“…Surgery is the optimal treatment option for lung cancer with favorable treatment efficacy for early stage lung cancer. VATS is clinically used to effectively minimize incision trauma with well-recognized effectiveness, safety, and faster recovery [ 11 , 12 ]. Nonetheless, the surgery is extremely demanding for the surgeon, and its long-term prognosis remains comparable to that of VATS.…”

Clinically important pulmonary vascular variations: a narrative review

“…Zhang and colleagues described the segmentectomy of S2R with multiple variations, including a lack of ascending A2R, which made exposing subsegmental arteries difficult and forced them to release the segmental hilum first ( 25 ). Other potentially problematic variants are a common root of A2R with A6 (with incidence between 1.53% to 12%) ( Figure 1E ), A3R, the inferior trunk, or three separate branches to S2R ( 17 , 23 , 24 , 26 ).…”

“…In the anterior type, V1-3R drains exclusively into the anterior vein, which has an incidence of 8.8% to 12%, and in the central type, V1-3 drains into the central vein, which has an incidence of 7% ( 17 , 18 ). The aforementioned case reported by Zhang also included a lack of second intrasegmental vein (V2b), which could potentially result in misidentification of other vessels as the intersegmental vein ( 25 ).…”