(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_20) contains supplementary material, which is available to authorized users.
The most frequent bronchial and arterial branching pattern of the basilar segments is B8 and B9+10 and A8 and A9+10 explaining that segmentectomy S9+10 is more frequently performed than segmentectomies S9 and S10.
20.1 Anatomical Landmarks (◘ Fig. 20.1)
Bronchus
The basilar bronchial trunk usually separates in two branches, B8 and B9+10, which run posterior to the segmental arteries (◘ Fig. 20.1a).
Fig. 20.1
Anatomical landmarks; a bronchus B9+10(front view), b arteries A9+10 (front view), c veins (inferior view)
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 A6 being mistaken for an A9+10 (◘ Fig. 20.1b).
Vein
The inferior basal vein (IBV), which is the lower root of the IPV, does not always represent the venous drainage of S9 and S10. One of its branches can drain S8 (◘ Fig. 20.1c). If any doubt, only the lowermost branch of the vein must be divided. It is however safer to control veins in the parenchyma.
20.2 Anatomical Variations and Pitfalls
Instead of A8 and A9+10, the following branching pattern can be encountered in 20% of patients: A8+9 and A10 or totally independent basal arteries (A8, A8, and A10). The same distribution is valid for bronchi. Preoperative modelization is helpful to avoid anatomical misjudgment.
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