# Thoracoscopic right anterior basal segmentectomy with unique anatomic variation: a case report and literature review

## TL;DR

A 55-year-old woman with lung cancer underwent a complex thoracoscopic surgery made possible by 3D imaging of unique anatomical variations.

## Contribution

The case highlights the use of 3D-CTBA for successful segmentectomy in the presence of rare anatomical variations.

## Key findings

- 3D-CTBA revealed unique vascular and bronchial variations in the right lower lobe.
- Thoracoscopic anterior basal segmentectomy was successfully performed with preoperative 3D planning.
- The case emphasizes the importance of detailed anatomical understanding in complex pulmonary surgeries.

## Abstract

Anatomic basal segmentectomy is often regarded as a complex procedure, particularly in the presence of complex anatomical variations.

Herein, we present a case of a 55-year-old female patient diagnosed with invasive lung adenocarcinoma. Three-dimensional computed tomography bronchography and angiography (3D-CTBA) displayed a unique combined variation in the basal segment of right lower lobe (RLL): The medial basal subsegmental bronchi (BX7a+BX7t) originated from both the anterior and posterior segmental bronchi; The medial basal subsegmental arteries emanated from the anterior and posterior basal segmental arteries; The medial anterior segmental vein shared a trunk with both the anterior basal and lateral basal subsegmental veins. With precise preoperative planning, thoracoscopic anterior basal segmentectomy was successfully executed.

This case again highlights the importance of 3D-reconstruction in pulmonary segmentectomy. Detailed understanding of anatomic features of segmental bronchi and vessels is imperative for those with complex anatomical variations.