LLL intra lobar JRS

Prenatal imaging showed a 4.5 by 4 by 4 centimeter left lower lobe mass

Chest X-ray at birth showed diffuse hazy lungs with no discrete masses

CT at 3 months of age showed a dense focal opacity in the left lower lobe with feeding vessel arising from the celiac axis below the diaphragm and branching within the sequestration

Several cysts at the periphery of the lesion were noted on CT imaging

An anterior approach was used using three ports: a 4 millimeter through the posterior axillary line for the telescope, two 3 millimeter ports placed in the anterior axillary line

The lower port was later changed to a 5 millimeter port for access of the 5 millimeter stapler and 5 millimeter clip applier

Several enlarged lymph nodes were present within the inferior pulmonary ligament

Adjacent to the artery was a cystic structure from which mucinous material was expressed

The systemic artery was double clipped on both sides and then divided with 3 millimeter scissors

An incomplete major fissure was identified and opened using a combination of 5 millimeter stapler, 3 millimeter scissors, and 3 millimeter sealer device

The major fissure was completed in a plane that was superficial to the pulmonary artery branches

The 3 millimeter sealer was first applied to the tissue to allow for cautery as well as crushing of the tissue prior to applying the 3 millimeter scissors

Each of the two segmental bronchi was divided using the 5 millimeter stapler

Placement of the Maryland clamp at the base of the vessel prior to firing of the stapler provides a protective measure in case the staples do not incorporate the entire line of transaction

The lowest incision was expanded from 5 millimeters to 1 centimeter, and the specimen removed piecemeal in its entirety

The chest tube was removed on post-op day 1 and the patient discharged home on post-op day 2

Final pathology showed lung lobe with sequestration and secondary changes of cystic pulmonary airway malformation

Early thoracoscopic surgery can be safely performed in infants with complex congenital lung malformations

The 3 millimeter sealer and 5 millimeter stapler facilitate a thorough dissection and complete excision of tissue in complex congenital lung malformations

Early surgical approach promotes conservation of lung parenchyma and reduces postoperative thoracic musculoskeletal deformity