Robotic Lingulectomy With Firefly-Assisted Bronchoscopic Transillumination

A 76-year-old male was incidentally noted to have a 2 cm left upper lobe lung nodule at the interface of the lingula and anterior segment. The nodule was PET avid, and a subsequent transbronchial biopsy suggested a carcinoid tumor. He underwent robotic-assisted lingulectomy, during which he was noted to have aberrant pulmonary arterial supply to the lingula with no lingular branches off the interlobar pulmonary artery, as is typically encountered. Given the unusual anatomy, surgeons performed intraoperative bronchoscopy with Firefly mode enabled, meaning that surgeons could visualize the location of the bronchoscope within the airway from the robotic console. This allowed for confirmation that the endoluminal carcinoid tumor was indeed distal to the area of dissection around the presumed lingular airway prior to its division. This case not only highlights a rare anatomical variant, but also demonstrates the utility of intraoperative airway identification for confirming the correct sublobar airway before division during any sublobar resection. 

References

1. LoCicero III J, Shields TW. Shields’ General Thoracic Surgery. Eighth ed: Lipincott, Williams, and Wilkins; 2018.
2. He H, Chen P, Chen X, Wang PY, Liu SY, Wang F. Analysis of anatomical variations of the lingular artery of the left upper lobe using 3D computed tomography angiography and bronchography. J Thorac Dis. 2021;13(8):5035-5041.

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