Thoracoscopic Sublobar Resection for Pulmonary Sequestration

The authors present the case of a 46-year-old woman with recurrent chest and urinary tract infections. Computed tomography of her chest demonstrated a right lower lobe intralobar pulmonary sequestration with an 8 mm systemic feeding vessel arising from the descending thoracic aorta.

A two-port video-assisted thoracoscopic surgery right lower sublobar resection was performed using a high-definition three-dimensional visualization system (Einstein Vision 3D, Aesculap, B. Braun, Germany) for enhanced in-depth appreciation. A 3 cm utility incision was formed in the 6th intercostal space at the midaxillary line, and a soft tissue retractor (Alexis O-Ring, Applied Medical, Rancho Santa Margarita, California, USA) was placed. A second 1 cm port was placed in the 8th intercostal space, anteriorly.

The feeding vessel to the sequestration was identified and dissected, and it was subsequently stapled distal to the application of an arterial clamp that was slowly released to test the hemostatic integrity of the staple line under systemic arterial pressures. The sequestration was then identified, isolated, and resected as a nonanatomical wedge. It required removal in a retrieval bag (Endo-Catch II, United States Surgical Corp, Norwalk, Connecticut, USA) due to copious purulent discharge from the specimen.

A paravertebral block was performed under direct vision, and a single pleural drain was placed posteriorly.

The chest drain was removed on the first postoperative day, and the patient was given intravenous antibiotics prophylactically for a total of 24 hours. She was fit for discharge on postoperative day three, following an uneventful postoperative course.