Thoracoscopic segmentectomy assisted by three-dimensional computed tomography bronchography and angiography for lung cancer in a patient living with situs inversus totalis: A case report

Abstract

BACKGROUNDSitus inversus totalis (SIT) is a rare congenital condition that is characterized by a complete mirror image of the typical arrangement of the thoracic and abdominal viscera. Performing thoracoscopic segmentectomy for a patient with lung cancer and SIT is an extremely skilled and challenging surgical procedure.CASE SUMMARYA 41-year old woman with a medical history of dextrocardia since childhood was admitted to our hospital with a mixed ground-glass opacity (mGGO) in her left lung field, discovered by computed tomography during her health checkup. In order to facilitate surgical orientation, three-dimensional computed tomography bronchography and angiography (3D-CTBA) was preoperatively carried out. The result of 3D-CTBA was consistent with the diagnosis of SIT and an mGGO in the posterior segment of the left upper lobe (LS2). Surgery was conducted in accordance with preoperative 3D-CTBA and designed surgical procedure, combined with intraoperative navigation. Final pathological examination revealed in situ adenocarcinoma. The patient’s postoperative condition was uneventful and no complications were observed.CONCLUSIONWe present the first case of lung cancer in a patient with SIT who successfully underwent thoracoscopic segmentectomy assisted by 3D-CTBA. This is a new technique that covers precise confirmation and dissection of targeted structures and intersegmental demarcation, and can help achieve a meticulous anatomical segmentectomy.

Surgical Treatment of Lung Cancer in Situs Inversus Totalis—A Case Report

“…Only eight studies reported a follow-up (6 months-2 years). The majority of cases were described in the eastern part of the world [15,18,19,21,22,[24][25][26][28][29][30][31]33,34]. Surprisingly, the presence of as many as three such cases was observed in Szczecin, in Europe.…”

“…The complex anatomy in SIT is a difficulty in the preoperative planning of thoracic procedures. Therefore, 3D-CT images were described in several included articles [28,29,33,34]. It is important to remember potential metastasis.…”

Robotic-assisted pulmonary lobectomy with lung cancer in a patient with situs inversus totalis

“…Regarding this surgical procedure in SIT patients with lung carcinoma, although previous reports showed cases of segmentectomy, lobectomy or pneumonectomy with the help of VATS, we did not find any case with the use of RATS in our literature review. Although Baruah [27] first reported the case of lung cancer with SIT in 1952 and Kodama performed the first lung cancer surgery in SIT patient in 1990 [28], surgery qualification for lung cancer/SIT patients is still difficult as there is a little experience of less than 30 lung cancer/SIT patients operation so far, among which only eleven cases were performed with video-assisted thoracic surgery [1,13,[29][30][31][32][33][34][35][36][37]. The majority of the study group was male (8/11), and adenocarcinoma was the most frequent pathological type (7/11).…”

Surgeon Knowledge of the Pulmonary Arterial System and Surgical Plan Confidence Is Improved by Interactive Virtual 3D-CT Models of Lung Cancer Patient Anatomies

“…This information can be difficult to capture from Computed Tomography (CT) alone. Standardof-care multi-detector CT images, enhanced with contrast agent for better delineation of the pulmonary vasculature, was first combined with volume rendering software to provide a threedimensional (3D) image of the patient's specific anatomy (9)(10)(11). More recently, modern medical image segmentation software has been applied to the contrast-enhanced CT scans to produce separable surface representations of the anatomical components (e.g., arterial, venous and bronchial systems).…”