(1)
IMM, Curie-Montsouris Thorax Institute, Paris, France
As there is no S7 on the left side, this segmentectomy is slightly easier than on the right side. However, variations in the distribution of arteries and bronchi require a thorough examination of preoperative modelization. In addition, division of the intersegmental plane can be difficult.
19.1 Anatomical Landmarks (◘ Fig. 19.1)
Fig. 19.1
Anatomical landmarks. a B8 bronchus (front view), b A8 artery (front view), c V8 veins. Note that the posterior branch of the superior basal vein (A8b) drains S9 and must be preserved
Bronchus
The basilar bronchial trunk usually separates in two branches: B8 and B9+10 which lie posterior to the segmental arteries (◘ Fig. 19.1a).
Arteries
The basilar arterial trunk branches in most cases in two arteries: A8 and A9+10. But all arteries to the lower lobe must be clearly identified in order to avoid misidentification, such as a low A8a being mistaken for an A9+10 (see below). When in doubt during dissection, it is preferable to control only the anterior branch of A8 (A8b), then the bronchus, and eventually check the direction of the second branch (◘ Fig. 19.1b).
Vein
The superior basal vein (SBV), which is the middle root of the IPV, does not always represent the venous drainage of segment 8. Its posterior branch can drain segment 9. It is advisable to divide only the anterior branch of the vein (V8a) which runs immediately behind the bronchus, rather than controlling V8 centrally in the inferior pulmonary vein (◘ Fig. 19.1c).