Abstract
Anatomical segmentectomy is an advantageous procedure because it spares healthy lung that has potential to show compensatory growth after lung resection and decreases the risk of air leak and residual resection, which becomes a problem in wedge resection. However, anatomical segmentectomy has not become a common procedure in pediatrics because it requires more complicated procedure than lobectomy or wedge resection, especially in patients with a history of pulmonary infection. In this case report, anatomical basal segmentectomy was safely performed with magnified vision by a hybrid video-assisted thoracic surgery (VATS) approach in a 6-year-old girl with intralobar pulmonary sequestration after severe pneumonia. The result suggests that the indications for hybrid VATS segmentectomy can expand further to include segmental lesions in children.
Highlights
Anatomical segmentectomy is an increasingly attractive alternative to lobectomy in selected adult patients.[1,2]
We present the case of a successful anatomical basal segmentectomy in a child with intralobar pulmonary sequestration (IPS) and recent pneumonia, using the invasive hybrid video-assisted thoracic surgery (VATS) approach.[4]
Pulmonary sequestration is a congenital lung malformation defined as nonfunctional lung tissue without a bronchial connection to normal lung.[5]
Summary
Anatomical segmentectomy is an increasingly attractive alternative to lobectomy in selected adult patients.[1,2] In children, the procedure is less common because of its technical complexity. She was diagnosed antenatally with IPS in the left lung with anomalous arterial supply to the left basal segment (►Fig. 1). She had no other symptoms prior to admission. A diagnosis of IPS was confirmed, and elective basal segmentectomy with a hybrid VATS approach was planned. An aberrant artery running through the pulmonary ligament was detected This was divided by silk thread ligation, clipping, and division using a bipolar system (the LigaSure vessel sealing system (Valleylab/Tyco Healthcare) (►Fig. 3a). The lung parenchyma was divided with the stapler on the inflation–deflation line between the affected basal segment and the healthy apical segment (►Fig. 4). No respiratory impairment was reported throughout the 1-year follow-up period
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