A Case of Robotic Right Lower Lobectomy for Lung Adenocarcinoma with Aberrant Branching of a^5b+7b+8b+10c Diagnosed by Preoperative 3D-CT

Abstract

It is known that the pulmonary arteries often aberrantly travel or branch, however, it is relatively rare that they branch from the right middle and lower lobe. We report a case of lung adenocarcinoma with a rare right aberrant pulmonary artery, which was treated by robotic right lower lobectomy. A 78-year-old woman was referred to our hospital due to a right lower lobe consolidation pathologically diagnosed as adenocarcinoma (cT1cN0M0, StageIA3). Preoperative three-dimensional computed tomography (3D-CT) revealed a 0.8 cm diameter aberrant mediastinal middle and inferior lobar branch (A5b+7b+8b+10c) from the right main pulmonary artery (PA). This variation was the first branch of the PA and running between the middle bronchial trunk and superior and inferior pulmonary vein. Robotic portal right lower lobectomy and systemic lymph node dissection were performed without any complications. To avoid an intraoperative injury, it is important to check vessel variation using preoperative 3D-CT and plan the safe operative procedure while considering anatomical anomalies.