Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2019; 7(22): 3844-3850
Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3844
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
Yun-Jiang Wu, Yang Bao, Ya-Li Wang
Yun-Jiang Wu, Yang Bao, Department of Thoracic Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
Ya-Li Wang, Department of Respiratory Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
Author contributions: All authors participated sufficiently in the work; Wu YJ is the first author; Wang YL is the corresponding author supervising the research; Wu YJ and Bao Y were the patient’s thoracic surgeons and contributed to manuscript drafting; Wang YL reviewed the literature and drafted the manuscript; all authors materially participated in this work and issued final approval for this version to be submitted.
Supported by The National Natural Science Foundation of China, No. 81800050; Natural Science Fund of Yangzhou City, No. YZ2017119; Science and Technology Innovation Cultivation Program of Yangzhou University, No. 2017CXJ122.
Informed consent statement: Written informed consent was obtained from the patient for publication of this manuscript along with any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ya-Li Wang, MD, Chief Doctor, Department of Respiratory Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou University, No. 368, Hanjiang Middle Road, Yangzhou 225009, Jiangsu Province, China. wyl1586135@126.com
Telephone: +86-514-82121199 Fax: +86-514-87213549
Received: June 15, 2019
Peer-review started: June 19, 2019
First decision: September 23, 2019
Revised: October 4, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: November 26, 2019
Abstract
BACKGROUND

Situs 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 SUMMARY

A 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.

CONCLUSION

We 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.

Keywords: Situs inversus totalis, Three-dimensional computed tomography bronchography and angiography, Thoracoscopic segmentectomy, Lung cancer, Case report

Core tip: Situs inversus totalis (SIT) is a rare congenital condition that is characterized by a complete transposition of major visceral organs. Surgical techniques in SIT patients are challenging as a result of their mirrored anatomy. A thorough understanding of segmental anatomy is thus important to avoid intraoperative accidental injuries. The three-dimensional computed tomography bronchography and angiography combined with image reconstruction with OsiriX software was found to be useful for image training before and during the surgery.