VATS Resection of Intralobar Sequestration

Bronchopulmonary sequestration is a benign, uncommon pulmonary anomaly characterized by the presence of a mass separated from the normal bronchopulmonary tree and a systemic aortic arterial blood supply (1).  
Intralobar sequestration consists of a lung mass surrounded by normal pulmonary tissue and is four times more common than the extralobar type. In contrast, extralobar sequestration has its own pleural investment and is separated from the normal lung parenchyma. 

In this video, a 49-year-old female patient presented with recurrent pneumoniaover the past year, with no history of lung infections. A computed tomography revealed a mass in the left lower lobe with a feeding artery from the descending aorta, clinically suspicious for intralobar pulmonary sequestration.  
The patient underwent triportal VATS: the aortic branch was carefully dissected from the pulmonary ligament, isolated, and transected with a vascular stapler. Pulmonary ligament division was then completed, and a small venous branch was identified, clipped, and then divided.  

The pulmonary ligament sectioning was conducted as far as the inferior pulmonary vein to fully mobilize the entire left lower lobe. A clear plane between pulmonary sequestration and healthy lung parenchyma was observed and divided using multiple loads of a parenchymal stapler. Complete lung re-expansion was observed, and the postoperative course was uneventful. The patient was discharged on postoperative day two. 

References

1. Bedoya MA, Ketwaroo P, Gagnon MH, Taylor S, Ndibe C, Mehollin-Ray AR. Congenital Chest Lesions and Interventions. Magn Reson Imaging Clin N Am. 2024 Aug;32(3):553-571.

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