2023 Volume 37 Issue 7 Pages 629-634
We report a case of fissureless lobectomy in a lung cancer patient with situs inversus totalis. A 67-year-old woman with situs inversus totalis undergoing maintenance hemodialysis presented to the hospital with an aneurysm at her vascular access point, and she was incidentally identified to have a left upper lobe nodule on computed tomography (CT). After a full-body examination including bronchoscopy, she was diagnosed with a cT1aN0M0, cStage IA1, adenocarcinoma and surgery was performed. Surgery was started using a hybrid video-assisted thoracic surgery approach with small thoracotomy. Intraoperative findings showed that the left lung was divided into three lobes, but because of incomplete lung fissures, fissureless lobectonomy was performed. Although the anatomical location of the pulmonary arteriovenous system and bronchi was a mirror image, we were able to perform fissureless lobectomy of the left upper lobe in the same manner as a normal right upper lobectomy because we understood the anatomy from the preoperative 3-dimensional (3-D) CT. Even in patients with situs inversus totalis, fissureless lobectomy may be feasible with careful preoperative planning, including 3-D CT.
