The patient presented with bilateral adenocarcinoma, therefore an apical and posterior segmentectomy was the procedure of choice in order to conserve pulmonary tissue and function.
A variance from normal anatomy was discovered intraoperatively, in that the superior pulmonary vein could not be identified. An aberrant vein was subsequently discovered draining directly into the innominate vein. This anatomical variance was not picked up on in the preoperative computed tomography scan. In this case, a 3D reconstruction of the pulmonary vasculature would have been particularly helpful. During the procedure, it was important to preserve the aberrant vein so as to not disturb the drainage of the remaining segments.
Having found one variance from normal anatomy, it was important to not miss any other potential variations. Intraoperative testing, of bronchi via inflation and vasculature via indocyanine green, was employed throughout the procedure to confirm anatomy and support decision making.
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