(1)
IMM, Curie-Montsouris Thorax Institute, Paris, France
In addition to the superior segment (S6), the lower lobe comprises four basal segments: medial (S7), anterior (S8), lateral (S9), and posterior (S10). The main steps of the procedure are similar to those of a right lower lobectomy. The main concern is the preservation of the elements of the S6 segment, especially the superior segmental vein (V6).
12.1 Anatomical Landmarks (◘ Fig. 12.1)
Fig. 12.1
Anatomical landmarks. a Basilar bronchi, in its most common pattern, i.e., early bifurcation in two branches, b Basilar arteries, i.e., early bifurcation in two branches, c basilar veins
Bronchus
The origin of the common basal trunk is found in the fissure 1–2 cm beyond the origin of B6 (◘ Fig. 12.1a).
Arteries
The arterial supply of the basal segments is the termination of the pulmonary artery after the birth of A6. It runs anterior to the segmental bronchus and usually separates into two main trunks, one for S7+8 and one for the posterior and lateral segments S9+10. It can also separate into three to four segmental branches (◘ Fig. 12.1b).
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. However, this pattern is theoretical and in most cases, the two basilar veins receive tributaries from adjacent segments. The superior vein (V6) must be clearly identified before stapling these two trunks (◘ Fig. 12.1c).
12.2 Anatomical Variations and Traps (◘ Fig. 12.2)
Fig. 12.2
Anatomical variations. a four basilar arteries, b middle lobe artery arising from the basilar arterial trunk, c middle lobe vein joining the inferior pulmonary vein; d basilar vein draining into the middle lobe vein
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