LAUSR

A 50-year-old female patient was admitted to our hospital for a lesion in right lower lobe (RLL). A high resolution computed tomography (HRCT) scan revealed a 13-mm GGO (ground glass opacity) in S7. Preoperative 3D-CTBA shows that B7 is anterior to inferior pulmonary vein (IPV), and there exist the B* for this patient. The intrasegmental vein is V7a and V7a’, that drain into the basal vein. The intersegmental vein is V7b, which drain into V8+9 (Figure 1). The main utility incision and observing port was made in the fourth and seventh intercostal space in anterior axillary line. Two assistant incisions were made in the seventh intercostal space in mid-axillary line and ninth intercostal space in posterior axillary line. The oblique fissure is first divided between the right middle lobe and the right lower lobe to identify the interlobar pulmonary artery and the A7 artery. The A7 artery is ligated and resected (Figure 2). The B7 bronchus, which runs on the ventral side of the IPV, is dissected and isolated, but not resected (Figure 3). Next, the right lung is ventilated by anesthesiologist using 100% oxygen. About 10 minutes later, a boundary is found between the inflated and deflated lung parenchyma to allow visualization of the anatomic intersegmental plane. The demarcation line was marked by electrocautery. During the 10-minutes-waiting, the B7 bronchus was resected using a stapler. The stump of the B7 bronchus was ligated with 2-0 silk and elevated. The intersegmental plane between S7 and S6, S8-10 was dissected using electrocautery along Letter to the Editor