Analysis of the variation pattern in right upper pulmonary veins and establishment of simplified vein models for anatomical segmentectomy

Kimihiro Shimizu, Toshiteru Nagashima, Yoichi Ohtaki, Kai Obayashi, Seshiru Nakazawa, Mitsuhiro Kamiyoshihara, Hitoshi Igai, Izumi Takeyoshi, Akira Mogi, Hiroyuki Kuwano, Kimihiro Shimizu, Toshiteru Nagashima, Yoichi Ohtaki, Kai Obayashi, Seshiru Nakazawa, Mitsuhiro Kamiyoshihara, Hitoshi Igai, Izumi Takeyoshi, Akira Mogi, Hiroyuki Kuwano

Abstract

Objective: Thoracic surgeons must be erudite pulmonary vein variation when performing anatomical segmentectomy. We used three-dimensional CT (3DCT) to accumulate variations of the pulmonary veins of the right upper lobe (RUL) and created a simplified RUL vein model.

Methods: We reviewed anatomical variations of the RUL pulmonary veins of 338 patients using 3DCT images, and classified them by position related with bronchus.

Results: Of the "anterior" and "central" RUL veins, all could be classified into 4 types: 2 Anterior with Central types (Iab and Ib), 1 Anterior type, and 1 Central type. The Anterior with Central type was observed in 273 patients (81 %), and was further classified into two types according to the origin of the anterior vein. In the Iab type, the anterior vein originated from V1a to V1b (54 %) whereas, in the Ib type, the anterior vein originated from only V1b (26 %). The Central type, which had no anterior vein, was evident in 23 cases (7 %). These three types could be further divided into three subcategories by reference to the branching pattern of the central vein. The Anterior type, which had no central vein, was evident in 42 cases (12 %), and this type could be further categorized into two types, depending on the branching pattern of the anterior vein.

Conclusion: We created a simplified RUL vein model to facilitate anatomical segmentectomy. Our models should find wide application, especially when thoracic surgery requiring anatomical RUL segmentectomy is planned.

Keywords: Pulmonary vein; Right upper lobe; Segmentectomy; Three-dimensional computed tomography.

Conflict of interest statement

All authors participated in this study and agreed on the content of this manuscript. No author has any financial or other relationship that could lead to a conflict of interest. None of the authors received any funding for this study. This research was approved by our institutional review board.

Figures

Fig. 1
Fig. 1
Types of branching of right upper lobe veins and each simplified models
Fig. 2
Fig. 2
Simplified models of the Iab type (Anterior with Central type)
Fig. 3
Fig. 3
Simplified models of the Ib type (Anterior with Central type)
Fig. 4
Fig. 4
Simplified models of the Central type
Fig. 5
Fig. 5
Simplified models of the Anterior type

References

    1. Harada H, Okada M, Sakamoto T, Matsuoka H, Tsubota N. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg. 2005;80:2041–2045. doi: 10.1016/j.athoracsur.2005.06.010.
    1. Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006;132:769–775. doi: 10.1016/j.jtcvs.2006.02.063.
    1. Yoshimoto K, Nomori H, Mori T, Kobayashi H, Ohba Y, Shibata H, et al. Quantification of the impact of segmentectomy on pulmonary function by perfusion single-photon-emission computed tomography and multidetector computed tomography. J Thorac Cardiovasc Surg. 2009;137:1200–1205. doi: 10.1016/j.jtcvs.2008.10.028.
    1. Nomori H, Okada M. Illustrated anatomical segmentectomy for lung cancer, 1st ed. New York: Springer; 2012.
    1. Ohtaki Y, Shimizu K. Anatomical thoracoscopic segmentectomy for lung cancer. Gen Thorac Cardiovasc Surg. 2014;62:586–593. doi: 10.1007/s11748-014-0409-7.
    1. Nagashima T, Shimizu K, Ohtaki Y, Obayashi K, Kakegawa S, Nakazawa S, et al. An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography. Gen Thorac Cardiovasc Surg. 2015;63:354–360. doi: 10.1007/s11748-015-0531-1.
    1. Shimizu K, Nakano T, Kamiyoshihara M, Takeyoshi I. Segmentectomy guided by three-dimensional computed tomography angiography and bronchography. Interact CardioVasc Thorac Surg. 2012;15(2):194–196. doi: 10.1093/icvts/ivs202.
    1. Oizumi H, Kanauchi N, Kato H, Endoh M, Suzuki J, Fukaya KS,, et al. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases. J Thorac Cardiovasc Surg. 2011;141(3):678–682. doi: 10.1016/j.jtcvs.2010.08.027.
    1. Boyden EA, Scannell JG. An analysis of variations in the bronchovascular pattern of the right upper lobe of 50 lungs. Am J Anat. 1948;82(1):27–73. doi: 10.1002/aja.1000820103.
    1. Yamashita H. Variations in the pulmonary segments and the bronchovascular trees. Roentgenologic anatomy of the lung. Tokyo: Igaku-syoin; 1978.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe