(1)
IMM, Curie-Montsouris Thorax Institute, Paris, France
Electronic Supplementary Material
The online version of this chapter (doi:10.1007/978-3-319-55901-8_18) contains supplementary material, which is available to authorized users.
The lower lobe comprises three basal segments: anterior (S8), lateral (S9), and posterior (S10). The main steps of the procedure are similar to those of a left lower lobectomy. The main concern is the preservation of the elements of the S6 segment, especially the superior segmental vein (V6) that can be tiny and fragile.
18.1 Anatomical Landmarks (◘ Fig. 18.1)
Fig. 18.1
Anatomical landmarks. a basilar bronchi, in its most common pattern, i.e., early bifurcation in two branches (anterior view); b basilar arteries, in its most common pattern, i.e., early bifurcation in two branches (anterior view); c basilar veins (posterior view)
Bronchus
The origin of the common basal trunk is found in the fissure 1–2 cm beyond the origin of B6 and the lingular bronchus (◘ Fig. 18.1a).
Arteries
The arterial supply of the basal segments is the termination of the pulmonary artery after the birth of the lingular artery and A6. It runs anterior to the segmental bronchus and usually divides into two main trunks, one for S8 and one for the posterior and lateral segments S9+10 (◘ Fig. 18.1b). It can also separate into three or four segmental branches.
Veins
The basal segments are drained by two venous trunks, the inferior basilar vein (IBV) for S9+10 and the superior basilar vein (SBV) for S8 (◘ Fig. 18.1c). The superior vein (V6) must be clearly identified before stapling these two trunks.
18.2 Anatomical Variations and Pitfalls (◘ Fig. 18.2)
The division of arterial branches is highly variable. The number of arteries ranges from one single basilar trunk to three or even four branches (◘ Fig. 18.2a–c).
A lingular artery can originate from the basilar artery sometimes at a low level (◘ Fig. 18.2d). It is thus essential to dissect the basilar arteries on a sufficient length.
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