Pulmonary sequestration 1: right lower lobe

Pulmonary sequestration is a rare congenital anomaly, characterized by aberrant lung tissue supplied by an aberrant systemic artery or arteries coursing within the inferior pulmonary ligament. The intralobar variety is the most frequent form. Clinical presentation may include recurrent haemoptysis and infection. Standard treatment involves surgical resection of the affected tissue with maximal preservation of healthy lung. This video tutorial presents the surgical technique for resecting intralobar pulmonary sequestration involving the right lower lobe. Rather than attempting to skeletonize the frequently friable aberrant artery(ies), the lung is mobilized, and the inferior pulmonary ligament containing the aberrant artery is isolated before being divided en masse; in this way, one may decrease the risk of intraoperative arterial injury and haemorrhage. Subsequent lung resection is performed in the standard fashion, in this case, an S10 segmentectomy. Transarterial embolization has been described both as a definitive treatment and as a preoperative intervention to decrease the risk of intraoperative bleeding. In the case of preoperative embolization, one must be wary to avoid embolic material when positioning the vascular stapler to divide the aberrant artery.