Enblock Resection of the Right Middle Lobe and Right Anterior Segment of the Upper Lobe for Middle Lobe Lung Cancer with Displaced B3

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There have been rare reports of B3 displacement from the right middle lobe (RML) bronchus. We report a case of thoracoscopic resection of the RML and anterior segment (S3) for RML lung cancer with B3 displacement from the RML bronchus. A 70-year-old woman was admitted to our hospital due to an abnormal shadow detected on chest radiography. Chest computed tomography (CT) revealed a middle lobe tumor and a displaced B3 bronchus originating from the RML. The tumor measured 30 mm in diameter; further, a transbronchial biopsy confirmed the adenocarcinoma diagnosis. We successfully performed a complete thoracoscopic resection of the RML and anterior segment of the right upper lobe. Given the limited knowledge of the lymphatic flow around the displaced bronchus, we opted for a reasonable approach to lymph node dissection. Preoperative assessments, including chest CT, bronchoscopy, and three-dimensional reconstructed CT scans, can facilitate preoperative bronchial and pulmonary vasculature identification.