Illustrated Anatomical Segmentectomy for Lung Cancer

Common trunk between the lingular arteries and A 3. An artery to the basilar trunk or to A 8 can rise from A 4. This underlines the need for an extensive dissection of the lingular artery. If this variation is encountered, the branches of the lingular artery must be controlled separately.

The lingular vein is the lowermost tributary of the superior pulmonary vein.

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However, in some patients, there are multiple radiating venous branches. In these cases, it is safer to divide only the lowermost branch. Once the lingula will become mobile thanks to the arterial and bronchial division, the venous drainage will become more apparent. A lingular vein can drain into the IPV Figure Venous drainage of the lingula into the inferior pulmonary vein arrow. IPV, inferior pulmonary vein. The superior segmental bronchus B 6 is the first branch of the lower lobe bronchus. It arises laterally and posteriorly and lies posterior to the segmental artery.

In obese or in some kyphotic patients, the bronchus can be located deeply and remote from A 6 , so that its identification and dissection can be difficult. It may be advisable to approach B 6 from the back and from below, after division of V 6 Figure Exposure and dissection of B 6.

Note that the bronchus can be at some distance from the artery. When single, A 6 artery bifurcates in 2 or 3 branches. The artery runs anterior to the segmental bronchus. A lymph node is frequently encountered close to the posterior aspect of A 6. It can tightly adhere to the artery and exposes to a vascular tear during dissection.

A 6 artery, in its most common pattern. Branches to segments 9 and 10 can be close to A 6 and should not be confused with a branch of A 6 Figure The superior segment is drained by the superior branch of the IPV V 6. V 6 can receive a venous branch from the basilar segments Figure In this case, only the uppermost tributary of V 6 must be clipped. Bifurcation of the V 6 vein: The origin of the common basal trunk is found in the fissure 1 to 2 cm beyond the origin of B 6 and the lingular bronchus. The arterial supply of the basal segments is the termination of the pulmonary artery after the birth of the lingular artery and A 6.

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It can also separate into 3 or 4 segmental branches. A lingular artery can originate from the basilar artery, sometimes at a low level Figure It is thus essential to dissect the basilar arteries on a sufficient length to avoid inadvertent clipping of the lingular artery. The lingular vein can meet up with the IPV Figure Lingular vein joining the inferior pulmonary vein.

Bs, stump of the basilar bronchial trunk; IPV, inferior pulmonary vein. The branching of the arteries and bronchi can be difficult to understand without help of a 3D modelisation. Same as for the corresponding arteries. There is a risk of dividing B 9 with B 8 or A 9 together with A 8. Common bronchial B 8 and B 9 trunk and common arterial A 8 and A 9 trunk. A 3D modelisation; B thoracoscopic view after clipping of A 8. A8s, stump of A 8.

The superior basal vein SBV , which is the middle root of the IPV, does not always represent the venous drainage of segment 8.

Its posterior branch can drain segment 9. It is advisable to divide only the anterior branch of the vein V 8a which runs immediately behind the bronchus, rather than controlling V 8 centrally in the IPV. These have been described in the previous paragraph. The same distribution is valid for bronchi. Preoperative modelisation is helpful to avoid anatomical misjudgment.

One of its branches can drain S 8. If any doubt, only the lowermost branch of the vein must be divided. It is however safer to control veins in the parenchyma. There are frequently no basal veins but just a branching into a common basal vein and V 6. This stress the need to favor venous control in the parenchyma rather than centrally in the IPV. The authors have no conflicts of interest to declare. National Center for Biotechnology Information , U.

Journal List J Thorac Dis v. Dominique Gossot 1 and Agathe Seguin-Givelet 1, 2. Author information Article notes Copyright and License information Disclaimer. I Conception and design: D Gossot; II Administrative support: D Gossot; IV Collection and assembly of data: D Gossot; V Data analysis and interpretation: D Gossot; VI Manuscript writing: All authors; VII Final approval of manuscript: Received Nov 2; Accepted Nov 8.

Copyright Journal of Thoracic Disease. Abstract The rate of sublobar resection SLR for early-stage non-small cell lung carcinoma NSCLC is increasing, mainly because of a growing rate of early-stage lung carcinomas and ground-glass opacities. Sublobar resection SLR , segmentectomy, lung cancer, anatomy. Open in a separate window. Arteries They arise from the truncus anterior TA and from the PA in the fissure, also named arterial truncus intermedius ascending arteries.

Veins In most cases, the segmental veins of the upper lobe are the two upper tributaries of the upper lobe vein: Right anterior segmentectomy S 3 Bronchus B 3 is the anterior branch of the upper bronchus. Arteries A 3 is the lowermost branch of the TA. Veins There are two types of veins: Right superior segmentectomy of the lower lobe S 6 Bronchus The superior segmental bronchus originates opposite or slightly above the middle lobe bronchus.

1. LIliade et lOdyssée (Annoté) (French Edition).
2. Ein Fratz auf vier Pfoten (German Edition).
3. Anatomical variations and pitfalls to know during thoracoscopic segmentectomies;

Arteries The superior segment of the right lower lobe is supplied by an artery A 6 which originates within the fissure at the same level than the basal trunk. Veins The vein to the superior segment is the uppermost and smaller segmental tributary V 6 of the inferior pulmonary vein IPV. Right basilar segmentectomy S 7—10 Bronchus The origin of the common basal trunk is found in the fissure 1 to 2 cm beyond the origin of B 6. Arteries The arterial supply of the basal segments is the termination of the pulmonary artery after the birth of A 6.

Arteries There are two different supplies to the let upper lobe: Veins The superior pulmonary vein has usually three major tributaries Figure 13A. Arteries The main supply to the lingula comes from the lingular trunk, which is the most anterior branch of the posterior segmental arteries.

Veins The lingular vein is the lowermost tributary of the superior pulmonary vein. Left superior segmentectomy of the lower lobe S 6 Bronchus The superior segmental bronchus B 6 is the first branch of the lower lobe bronchus. Left basilar segmentectomy S 8—10 Bronchus The origin of the common basal trunk is found in the fissure 1 to 2 cm beyond the origin of B 6 and the lingular bronchus. Arteries The arterial supply of the basal segments is the termination of the pulmonary artery after the birth of the lingular artery and A 6.

Lingular artery originating from the basilar arterial trunk. LUL, left upper lobe. Footnotes Conflicts of Interest: Totally thoracoscopic pulmonary anatomic segmentectomies: J Thorac Dis ; 5: Atlas of endoscopic major pulmonary resections. Update on three-dimensional image reconstruction for preoperative simulation in thoracic surgery. J Thorac Dis ; 8: Preoperative assessment of the pulmonary artery by three-dimensional computed tomography before video-assisted thoracic surgery lobectomy.

Eur J Cardiothorac Surg ; High-quality 3-dimensional image simulation for pulmonary lobectomy and segmentectomy: Three dimensional computed tomography lung modeling is useful in simulation and navigation of lung cancer surgery.

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