Ten cases of intradiaphragmatic extralobar pulmonary sequestration: a single-center experience

Intradiaphragmatic extralobar pulmonary sequestration (IDEPS) is a rare type of pulmonary sequestration (PS). The purpose of this study is to assess diagnosis and operative treatment of IDEPS.

Patients with PS who were diagnosed and treated in our center from January 2015 to December 2020 were analyzed retrospectively to identify patients with IDEPS.

Totally, 215 patients with PS were treated surgically, including 10 cases with IDEPS. Prenatal ultrasounds and postnatal-enhanced CT showed the presence of IDEPS in four cases and in seven cases, respectively. The three-dimensional (3D) reconstruction software was performed perfectly to identify the location of the lesions in 10 cases. The surgeries were performed smoothly by laparoscopic surgery in one case, video-assisted thoracic surgery (VATS) in five cases and Da Vinci robot-assisted thoracoscopic surgery (DVRATS) in four cases. In the VATS group, the average operative duration, intraoperative blood loss volume, length of stay after operation, and postoperative thoracic catheter indwelling duration were 48 min, 3.8 mL, 6.4 days and 2.2 days, respectively. That of the DVRATS group were 80 min, 3.5 mL, 4.3 days and 1.5 days, respectively. No side effects had appeared.

The 3D reconstruction software was proven to be capable in assisting the assessment of IDEPS. We suggested early surgery to treat IDEPS, and the best path was accessing the mass from the chest. Both DVRATS and VATS for the treatment of an IDEPS are safe, feasible, and effective. Furthermore, DVRATS provides a 3D magnified view, more flexibility and precision.