Thoracoscopic Right Lower Lobectomy With Right Top Pulmonary Vein: Safe Subcarinal Lymph Node Dissection

The right top pulmonary vein (RTPV) is a rare venous anomaly arising from the posterior segmental vein, which runs dorsal to the bronchus intermedius. This anatomy increases the risk of vascular injury during right lower lobectomy, particularly during subcarinal lymph node dissection and fissure division.

We describe thoracoscopic right lower lobectomy with subcarinal lymph node dissection in a patient with RTPV. Key techniques include circumferential dissection of the RTPV and a fissure-last technique.

This approach enabled safe preservation of the anomalous vein and adequate exposure of the subcarinal space for complete lymph node dissection.

This case highlights practical strategies for preserving anomalous veins and enabling safe subcarinal lymph node dissection, contributing to reproducible thoracoscopic surgery.