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Thoracoscopic Resection of Extralobar Bronchopulmonary Sequestration
Chapter 1 of 5 · Case-Based Learning
Case presentation
Case presentation and preoperative imaging
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The diagnosis of extralobar bronchopulmonary sequestration was made on fetal ultrasound when a discrete solid left thoracic mass with a systemic feeding vessel was seen.
The patient was asymptomatic at birth and remained so.
CT scan at 4 months of age showed an extralobar bronchopulmonary sequestration with a discrete systemic feeding vessel arising from the subdiaphragmatic aorta.
The patient had a focal diaphragmatic eventation at the site of the sequestration.
The patient was operated in a right semi-prone position with right main stem intubation.
The sequestration is tethered to the diaphragm.
Mobilization starts by dividing the diaphragmatic pleura at the junction with the sequestration.
This dissection is started with the hook cautery and continued with the ligature.
The feeding vessels will be within the tissues attaching the sequestration to the diaphragm.
The systemic feeding vessel has to be skeletonized to allow for safe control and division.
Skeletonization is done by dividing the tissue adjacent to the vessel and creating a free plane behind the vessel.
Once well skeletonized, 2 clips are placed on the vessel proximally, and the ligature is applied distally.
A combination of sharp and blunt dissection is used to separate the sequestration from the diaphragm.
A second vessel was identified more medially and was likewise clipped and divided with ligature.
The associated focal eventation is repaired with two interrupted sutures.
The mass is removed by slightly enlarging the most posterior trochar site.
A chest tube is not placed.
The patient was discharged home the day after the operation and had an excellent recovery.