Surgical case reports · 2025
Robotic Segmentectomy in a Patient with a Displaced Left Upper Division Bronchus and Fused Fissure.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Wada Hironobu, Karita Ryo, Hirai Yuki, Onozato Yuki, Kamata Toshiko, Tamura Hajime, Anayama Takashi, Yoshino Ichiro, Yoshida Shigetoshi
Аннотация
INTRODUCTION: In thoracic surgery, anatomical anomalies and a fused fissure can cause inaccurate intraoperative recognition of anatomy and lead to accidental injury of pulmonary vessels and bronchi that should be preserved. A displaced left upper division bronchus (B1+2+3), also known as a left eparterial bronchus, is a rare anomaly that can present in combination with abnormal pulmonary arteries positioning and lobulation. Herein, we report a case of lung cancer in S1+2 of the left fused lung that was successfully resected by robotic left upper division segmentectomy following a detailed preoperative simulation using 3-dimensional computed tomography.
CASE PRESENTATION: A female octogenarian presented for the treatment of simultaneous bilateral lung cancer. Three months after surgery for right lung cancer, a surgery for left lung cancer was performed. Preoperative computed tomography identified several broncho-arterial anomalies and a completely fused fissure, including a displaced left upper division bronchus and a pulmonary artery running anteriorly to the left main bronchus, similar to those in the right lung. Robotic left upper division segmentectomy with lymph node dissection was performed using a "hilum first, fissure last" approach with fine dissection of the hilar structures and minimal bleeding. The postoperative course was uneventful.
CONCLUSIONS: Preoperative simulation and robotic-assisted thoracoscopic surgery enabled the safe and precise anatomical pulmonary segmentectomy for a patient with lung cancer, despite several bronchial and arterial anomalies, including a displaced left upper division bronchus.
CASE PRESENTATION: A female octogenarian presented for the treatment of simultaneous bilateral lung cancer. Three months after surgery for right lung cancer, a surgery for left lung cancer was performed. Preoperative computed tomography identified several broncho-arterial anomalies and a completely fused fissure, including a displaced left upper division bronchus and a pulmonary artery running anteriorly to the left main bronchus, similar to those in the right lung. Robotic left upper division segmentectomy with lymph node dissection was performed using a "hilum first, fissure last" approach with fine dissection of the hilar structures and minimal bleeding. The postoperative course was uneventful.
CONCLUSIONS: Preoperative simulation and robotic-assisted thoracoscopic surgery enabled the safe and precise anatomical pulmonary segmentectomy for a patient with lung cancer, despite several bronchial and arterial anomalies, including a displaced left upper division bronchus.