Department of General Thoracic Surgery, National Hospital Organization, Saitama Hospital, Suwa 2-1, Wako, Saitama, 351-0102, Japan.
J Cardiothorac Surg. 2024 Mar 19;19(1):136. doi: 10.1186/s13019-024-02627-9.
A right-sided aortic arch is a rare congenital vascular structure variation. Right lobectomy is not commonly performed on patients with such a condition. Further, there are no reports on lobectomy under uniportal video-assisted thoracoscopic surgery (VATS) in this patient group.
A 67-year-old man with a right-sided aortic arch and Kommerell diverticulum underwent right upper lobectomy with mediastinal lymph node dissection under uniportal VATS for primary lung cancer. Due to the right descending aorta, which narrows the space of the dorsal hilum, handling of the stapler for stapling the right upper lobe bronchus from the uniport in the 6th intercostal space at the medial axillary line can be challenging. This issue was resolved by manipulating the staple over the azygos vein toward the inferior margin of the aortic arch. Via mediastinal lymphadenectomy, we found that the right recurrent laryngeal nerve branched from the right vagus nerve and hooked around the right-sided aortic arch.
Right lobectomy with mediastinal lymph node dissection under uniportal VATS can be performed for lung cancer in patients with a right-sided aortic arch.
右位主动脉弓是一种罕见的先天性血管结构变异。对于此类患者，通常不进行右肺叶切除术。此外，在该患者群体中，尚无关于单端口电视辅助胸腔镜手术（VATS）下肺叶切除术的报道。
一名 67 岁男性，患有右位主动脉弓和 Kommerell 憩室，因原发性肺癌，在单端口 VATS 下行右上肺叶切除术和纵隔淋巴结清扫术。由于右降主动脉狭窄了背侧肺门的空间，因此从腋中线第 6 肋间的单端口处理用于吻合右上肺叶支气管的吻合器可能具有挑战性。通过将吻合器沿奇静脉向主动脉弓下缘操作，解决了这一问题。通过纵隔淋巴结清扫术，我们发现右喉返神经发自右迷走神经并绕过右位主动脉弓。
对于患有右位主动脉弓的肺癌患者，可在单端口 VATS 下行右肺叶切除术和纵隔淋巴结清扫术。
