Surgical Case Reports最新文献

{"title":"A Unique Case of Intra-Abdominal Diffuse Lymphangiomatosis Mimicking a Pseudomyxoma Peritonei.","authors":"Andreas R R Weiss, Georg F Weber, Maximilian Brunner, Robert Grützmann, Abbas Agaimy, Christian Krautz","doi":"10.70352/scrj.cr.24-0037","DOIUrl":"10.70352/scrj.cr.24-0037","url":null,"abstract":"<p><strong>Introduction: </strong>Localized cystic lymphangiomas (CL) are rare benign tumors deriving from the lymphatic system. CL is diagnosed more frequently in children than in the adult population and, although commonly affecting the cervical and axillary regions, can develop in various parts of the body. Abdominal cystic lymphangioma (ACL) comprises less than 5% of all CL cases.</p><p><strong>Case presentation: </strong>A 35-year-old female patient with a history of benign appendectomy in childhood was transferred to our tertiary center for the operative management of a suspected extensive pseudomyxoma peritonei (PMP). In accordance with the multidisciplinary team discussion, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy was planned. Intraoperatively, a typical \"jelly belly\" with high disease burden throughout the abdominal cavity and the small pelvis was found. A multi-visceral resection with complete cytoreduction (CCR 0) was performed. The postoperative histopathological findings revealed a diffuse, partially cystic lymphangiomatosis involving the peritoneum extensively without evidence of PMP or malignancy.</p><p><strong>Conclusions: </strong>ACLs are uncommon in the adult population, and diffuse peritoneal involvement is even rarer. Surgical management with complete resection is the preferred treatment option. Other benign cysts, as well as infectious diseases and malignancy, should be considered during the preoperative workup.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Pancreatojejunostomy for Pancreaticodigestive Reconstruction in the Resection of Pancreatic Head Malignancy with Chronic Pancreatitis: A Case Report.","authors":"Hironori Hayashi, Yuichiro Furutani, Hiroaki Sugita, Kei Sugano, Takahiro Yoshimura, Tetsuro Oda, Daisuke Fujimori, Koichiro Sawada, Masanori Kotake, Kaeko Oyama, Shintaro Yagi, Takuo Hara","doi":"10.70352/scrj.cr.24-0015","DOIUrl":"10.70352/scrj.cr.24-0015","url":null,"abstract":"<p><strong>Introduction: </strong>With progress in pancreatic surgery, a preservation of residual organ function has become more important. Pancreatic malignancies are occasionally accompanied by chronic pancreatitis (CP) and pancreatolithiasis (PL). Longitudinal pancreatojejunostomy (LPJ) is reportedly a useful method of surgical management in cases of CP with PL. We describe a patient with pancreatic head intraductal papillary mucinous carcinoma (IPMC) concomitant with PL, who underwent subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and LPJ for reconstruction.</p><p><strong>Case presentation: </strong>A man in his 70s was referred to our hospital with a pancreatic head tumor. He had been treated for CP, diabetes mellitus, and chronic kidney disease. Imaging revealed a cystic pancreatic head tumor with a solid component that was histologically confirmed as IPMC. In addition, multiple calcifications suggestive of PL were observed in the pancreatic body and tail. SSPPD and LPJ were performed to excise the PL as much as possible and preserve the residual pancreatic function. The postoperative course was uneventful, and no abdominal symptoms or tumor recurrences were observed for approximately 8 months after surgery.</p><p><strong>Conclusion: </strong>This patient with IPMC with residual pancreatic PL was treated with SSPPD and LPJ to maximize the residual pancreatic function and reduce the occurrence of postoperative pancreatitis.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Mitral Stenosis and Regurgitation Due to Bioprosthetic Valve Failure with Massive Pannus.","authors":"Ryota Hara, Sho Torii, Joji Ito, Yohei Ohno, Minoru Tabata","doi":"10.70352/scrj.cr.24-0095","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0095","url":null,"abstract":"<p><strong>Introduction: </strong>Bioprosthetic valve failure after mitral valve replacement is a well-recognized phenomenon, with pannus overgrowth being one notable cause. The standard treatments include redo surgical mitral valve replacement and the less invasive transcatheter treatment, mitral valve-in-valve. However, the feasibility and safety of performing mitral valve-in-valve when pannus overgrowth has reduced the valvular opening to a mere pinhole remains uncertain.</p><p><strong>Case presentation: </strong>A 76-year-old woman, who had previously undergone mitral valve replacement, was admitted for congestive heart failure. Severe mitral stenosis and severe mitral regurgitation were diagnosed using transthoracic echocardiography. During redo mitral valve replacement, we observed that the prosthetic valve leaflets on the left atrial side were almost entirely covered with pannus tissue, leaving only a central pinhole for blood flow. Macroscopic and microscopic examination of the bioprosthesis revealed accordion-like leaflet deformation on the ventricular side.</p><p><strong>Conclusions: </strong>Although the transcatheter valve-in-valve procedure is recognized as a less invasive treatment option for degenerated biological valves, in certain cases such as ours, open surgery becomes imperative as the most appropriate treatment.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Ampullary Carcinoma with Complete Duodenal Obstruction as the Initial Manifestation.","authors":"Yuta Kakizaki, Akefumi Sato, Yoshitaka Enomoto","doi":"10.70352/scrj.cr.25-0020","DOIUrl":"https://doi.org/10.70352/scrj.cr.25-0020","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive jaundice is often the first symptom of ampullary carcinoma, with a straightforward preoperative diagnosis. We report a rare case of ampullary carcinoma without jaundice as the initial symptom.</p><p><strong>Case presentation: </strong>A 53-year-old man was admitted with abdominal distension and recurrent vomiting. Esophagogastroduodenoscopy revealed a complete duodenal obstruction without malignant findings. Computed tomography revealed wall thickening in the second portion of the duodenum. The common bile duct and main pancreatic duct were not dilated. As there was no evidence of malignancy, we performed gastrojejunostomy as a bypass to improve the symptoms. Five months later, follow-up blood examinations showed elevated total bilirubin levels, and computed tomography revealed persistent thickening of the duodenal wall with exacerbated dilation of common bile duct and main pancreatic duct. Mucosal biopsies from the oral and anal sides of the stenosis revealed no malignancy. Due to a strong suspicion of malignant disease and difficulty in preoperative biliary drainage, we performed pancreatoduodenectomy. Pathological examination revealed mucinous adenocarcinoma with submucosal and subserosal invasion of the duodenum. We finally diagnosed this case as ampullary carcinoma.</p><p><strong>Conclusions: </strong>The possibility of malignancy should be considered even in cases of duodenal obstruction that have not been diagnosed as malignant after repeated close examination.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benign Cystic Mesothelioma of the Peritoneum Arising at the Greater Omentum in a 14-Year-Old Boy.","authors":"Yutaka Hirayama, Naruki Higashidate, Kengo Nakaya, Yasushi Iinuma","doi":"10.70352/scrj.cr.24-0085","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0085","url":null,"abstract":"<p><strong>Introduction: </strong>Mesothelioma arises from mesothelial cells. This tumor is very rare among pediatric abdominal neoplasms. We herein report an extremely rare case of acute abdomen with cystic mesothelioma of the peritoneum in a child.</p><p><strong>Case presentation: </strong>A 14-year-old boy was referred to our hospital for emergency surgery. Surgery revealed a primary tumor arising from the greater omentum. The tumor was macroscopically diagnosed as a benign omental lymphangioma and was resected en bloc with the greater omentum. A histopathological examination of the tumor revealed a simple columnar epithelium-like mesothelioma with poor cell-atypia. Immunohistochemical examination showed antibody reactivity in the cyst epithelium, including an anti-calretinin antibody. The final pathological diagnosis was a mesothelioma originating from the peritoneum.</p><p><strong>Conclusions: </strong>In pediatric cases diagnosed with cystic lymphatic malformation, the possibility of peritoneal mesothelioma needs to be considered and carefully confirmed or ruled out.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Artery Stent-Graft Implantation Using the Retrograde Approach in a Patient Who Developed a Renal Artery Aneurysm after Thoracoabdominal Aortic Repair.","authors":"Yutaka Matsubara, Tadashi Furuyama, Toshihiro Onohara","doi":"10.70352/scrj.cr.24-0121","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0121","url":null,"abstract":"<p><strong>Introduction: </strong>Herein, we report a patient who underwent stent-graft implantation using the retrograde approach for a renal artery aneurysm.</p><p><strong>Case presentation: </strong>The patient was a 48-year-old man who underwent total arch replacement, thoracoabdominal aortic repair, aortic root replacement, and thoracic endovascular aortic repair for Marfan syndrome. A right renal artery aneurysm developed at the prosthetic graft anastomosis during observation. First, stent-graft implantation using the antegrade approach was performed. However, the delivery system could not be advanced to the right renal artery because of prosthetic graft kinking. Therefore, the procedure was discontinued. Next, the retrograde approach was used. A right hypochondral oblique incision was made. The right renal artery was exposed with the retroperitoneal approach, and a stent graft was retrogradely inserted into the renal artery and deployed between the prosthetic graft and the distal right renal artery to cover the aneurysm. The patient was followed up for 3 years after the surgery, and he did not develop any aneurysm.</p><p><strong>Conclusions: </strong>Renal artery stent graft implantation using the retrograde approach can be a treatment option for renal artery aneurysms in patients with a hostile abdomen.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Acute Pancreatitis after Pancreatectomy in Grade C Leading to Walled-Off Necrosis Successfully Treated with Necrosectomy by Retroperitoneal Approach.","authors":"Makoto Shinohara, Masakazu Hashimoto, Ryo Nagao, Michinori Hamaoka, Masashi Miguchi, Nobuaki Fujikuni, Satoshi Ikeda, Yasuhiro Matsugu, Hideki Nakahara","doi":"10.70352/scrj.cr.24-0002","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0002","url":null,"abstract":"<p><strong>Introduction: </strong>Grade B or C post-pancreatectomy acute pancreatitis (PPAP) is associated with a higher incidence of postoperative complications and mortality. The reason for this is the activation of proteolytic processes that can lead to pancreatic destruction and the activation of systemic reactions that can have adverse consequences such as systemic inflammatory response syndrome, sepsis, and death. We report a case of a patient with Grade C PPAP with walled-off necrosis (WON) who was successfully treated with necrosectomy using a step-up approach.</p><p><strong>Case presentation: </strong>A 73-year-old man was referred to our hospital with elevated biliary enzymes. Results of blood tests, computed tomography (CT), and magnetic resonance imaging led to the diagnosis of distal bile duct cancer. He underwent a pyloric ring-sparing pancreaticoduodenectomy with lymph node dissection. Postoperative P-AMY (pancreatic amylase) was high at 1766 U/L, and contrast-enhanced CT showed increased density of peripancreatic fatty tissue and fluid accumulation on the pancreatic resection surface, leading to the diagnosis of postoperative pancreatitis and pancreatic fistula. On postoperative day (POD) 9, continuous washing with saline solution was started through the drain at the pancreatic anastomosis. Contrast-enhanced CT showed increased fluid retention in the pancreatic body tail. On POD 43, endoscopic ultrasonography drainage was performed for pancreatic necrosis encapsulated in the retroperitoneum; however, the patient self-extracted the drainage tube. On POD 50, CT-guided drainage was performed for a retroperitoneal subcapsular abscess. On POD 69, the patient underwent necrotomy with guided retroperitoneal drainage, a drain was inserted, and continuous flushing was performed. On POD 76, fecal discharge was observed from the drain, and drainage and enterography were performed; a fistula with the colon was confirmed, and an ileal bifurcation colostomy was performed on the same day. On PODs 83, 85, and 100, endoscopic necrotomy was performed through a retroperitoneal incision wound because a contrast-enhanced CT showed a residual abscess on the gastric dorsum. The patient's general condition improved, and his inflammatory response also improved. On POD 139, the patient was transferred for rehabilitation.</p><p><strong>Conclusion: </strong>We describe a case of successful postoperative nutritional management and necrosectomy for Grade C PPAP leading to WON.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of a Complex Posterior Tracheal Wall Defect via Transtracheal Running Suture and Pedicled Pectoralis Major Muscle Flap.","authors":"Tomoyuki Nakagiri, Alaa Selman, Tobias Goecke, Hayan Merhej, Akylbek Saipbaev, Arjang Ruhparwar, Patrick Zardo","doi":"10.70352/scrj.cr.24-0009","DOIUrl":"10.70352/scrj.cr.24-0009","url":null,"abstract":"<p><strong>Introduction: </strong>A tracheal membranous injury is a known complication of tracheostomy. After esophageal resection, such injury may prove fatal. No natural buttressing of the lesion occurs, and severe sepsis and mediastinitis may occur. In these situations, a circumferential tracheal resection is the treatment of choice, sometimes on cardiopulmonary bypass. However, the outcome is not always favorable.</p><p><strong>Case presentation: </strong>We report a case of a long tracheal membranous wall defect (> 7cm) after esophageal resection. We successfully performed a transtracheal direct repair of the defect through a partial sternotomy, and reconstructed the ventrolateral wall with a muscle flap using the right pectoralis major muscle.</p><p><strong>Conclusion: </strong>Tracheal reconstruction through a T-shaped incision and anastomotic buttressing using a pectoralis major muscle flap could prove to be useful when reconstructing a posterior tracheal wall injury, especially after esophageal resection.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Laparoscopic Resection of Gastric Cancer Using Novel Laparoscopic Fluorescence Spectrum System and Near-Infrared Fluorescent Clips.","authors":"Shion Uemura, Yuma Ebihara, Kazuya Konishi, Satoshi Hirano","doi":"10.70352/scrj.cr.24-0028","DOIUrl":"10.70352/scrj.cr.24-0028","url":null,"abstract":"<p><strong>Introduction: </strong>In laparoscopic gastrectomy, accurate marking of the lesion site is essential in determining the resection line of the stomach, owing to the lack of haptics and the direct link between negative pathological margins and prognosis. Intraoperative endoscopy may require personnel and prolong the operation time, whereas preoperative endoscopic tattooing using India ink faces problems related to the spread of ink and visibility. ZEOCLIP FS (Zeon Medical, Tokyo, Japan) is a clip made of fluorescent resin, covered by insurance since March 2019. It can be visualized from the serosal side using a near-infrared scope; however, its weak fluorescence intensity often poses viewing difficulties. Lumifinder (ADVANTEST, Tokyo, Japan) is a laparoscopic fluorescence spectrum system available for clinical use since February 2023. It can measure fluorescence intensity using a near-infrared laser and detect weak fluorescent signals. We report a case of gastric cancer in which the location of the lesion was confirmed intraoperatively using ZEOCLIP FS and Lumifinder.</p><p><strong>Case presentation: </strong>A man in his 80s was diagnosed with gastric cancer following an examination for anemia. Two lesions were found: a 0-IIc type (cT1) at the lesser curvature of the gastric angle and a type 1 tumor (cT2) at the anterior wall of the upper gastric body. The preoperative assessment indicated no lymph node or distant metastasis. The tumor was diagnosed as cStage I and laparoscopic distal gastrectomy was planned. Two ZEOCLIP FS clips were placed on the oral side of the tumor on the anterior wall of the upper gastric body on the day before surgery. During surgery, fluorescent signals from the clips were detected using Lumifinder, enabling easy confirmation of the lesion location and determination of the gastric resection line.</p><p><strong>Conclusions: </strong>The combined use of ZEOCLIP FS and Lumifinder was a useful new method for identifying the appropriate resection line of the stomach. We plan to evaluate this method further in additional cases to enhance the detection efficacy.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Segmentectomy in a Patient with a Displaced Left Upper Division Bronchus and Fused Fissure.","authors":"Hironobu Wada, Ryo Karita, Yuki Hirai, Yuki Onozato, Toshiko Kamata, Hajime Tamura, Takashi Anayama, Ichiro Yoshino, Shigetoshi Yoshida","doi":"10.70352/scrj.cr.25-0039","DOIUrl":"10.70352/scrj.cr.25-0039","url":null,"abstract":"<p><strong>Introduction: </strong>In thoracic surgery, anatomical anomalies and a fused fissure can cause inaccurate intraoperative recognition of anatomy and lead to accidental injury of pulmonary vessels and bronchi that should be preserved. A displaced left upper division bronchus (B¹⁺²⁺³), also known as a left eparterial bronchus, is a rare anomaly that can present in combination with abnormal pulmonary arteries positioning and lobulation. Herein, we report a case of lung cancer in S¹⁺² of the left fused lung that was successfully resected by robotic left upper division segmentectomy following a detailed preoperative simulation using 3-dimensional computed tomography.</p><p><strong>Case presentation: </strong>A female octogenarian presented for the treatment of simultaneous bilateral lung cancer. Three months after surgery for right lung cancer, a surgery for left lung cancer was performed. Preoperative computed tomography identified several broncho-arterial anomalies and a completely fused fissure, including a displaced left upper division bronchus and a pulmonary artery running anteriorly to the left main bronchus, similar to those in the right lung. Robotic left upper division segmentectomy with lymph node dissection was performed using a \"hilum first, fissure last\" approach with fine dissection of the hilar structures and minimal bleeding. The postoperative course was uneventful.</p><p><strong>Conclusions: </strong>Preoperative simulation and robotic-assisted thoracoscopic surgery enabled the safe and precise anatomical pulmonary segmentectomy for a patient with lung cancer, despite several bronchial and arterial anomalies, including a displaced left upper division bronchus.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}