Pulmonary sequestration 2: left lower lobe.

Abstract

Pulmonary sequestration is a rare congenital anomaly, characterized by aberrant lung tissue supplied by an aberrant systemic artery or arteries coursing within the inferior pulmonary ligament. The intralobar variety is the most frequent form. Clinical presentation may include recurrent haemoptysis and infection. Standard treatment involves surgical resection of the affected tissue with maximal preservation of healthy lung. This video tutorial presents the surgical technique for resecting intralobar pulmonary sequestration involving the left lower lobe. Rather than attempting to skeletonize the frequently friable aberrant artery(ies), the lung is mobilized and the inferior pulmonary ligament containing the aberrant artery is isolated and  "thinned out" before being divided en masse; in this way, one may decrease the risk of intraoperative arterial injury and haemorrhage. Subsequent lung resection is performed in standard fashion, in this case a left lower lobectomy. Transarterial embolization has been described both as definitive treatment and as a preoperative intervention to decrease the risk of intraoperative bleeding. In the case of preoperative embolization, one must be wary of the possibility of embolic material interfering with the application of the vascular stapler when dividing the aberrant artery, and fine embolic material should be chosen.