Left basilar VATS segmentectomy for intra lobar pulmonary sequestration using indocyanine green for identification of the intersegmental plane: a case report

Abstract

: Pulmonary sequestration is a rare congenital abnormality that requires surgical resection if symptomatic. The pulmonary sequestration can be extra lobar with a separate visceral pleura, artery and venous drainage or intra lobar contained within the visceral pleura of the lung with a separate artery and venous drainage to the pulmonary vein. Rarely the entire lobe is affected in intra lobar sequestration and segmentectomy should be considered rather than lobectomy. A case of an intra lobar sequestration in the left lower lobe with a feeding artery coming from the descending thoracic aorta is presented. The patient was a young woman, who had experienced recurrent pneumonia for one year. A left video-assisted thoracoscopic surgery (VATS) basilar segmentectomy was performed using a standardized anterior three-port approach. Due to the recurrent infections, the hilar lymph nodes were fibrotic, and dissection was performed using an advanced energy system. Identification of the intersegmental plane may be challenging in segmentectomies. Most surgeons use an inflation-deflation technique. In this case identification was performed using a near-infra red camera and intravenous injection of indocyanine green. Identification was successful. The postoperative course was uneventful with a length of stay of two days. On follow up 6 months postoperatively, the patient was without any symptoms.