Combined subsegmentectomy for S2 b (horizontal subsegment of the posterior segment) and S3 a (lateral subsegment of the anterior segment) in the right upper pulmonary lobe

A technique for combined resection of S(2)(b) (horizontal subsegment of the posterior segment) and S(3)(a) (lateral subsegment of the anterior segment) of the right upper lobe of the lung is presented. Although both the S(2)(b) and S(3)(a) should be resected from the interlobar fissure, an approach for the artery and bronchus of S(3)(a) (A(3)(a) and B(3)(a), respectively) is easier from the ventral side of the hilum rather than from the interlobar fissure, because B(3) runs in back of V(2) at the interlobar fissure. To resolve this contradiction, we devised a procedure as follows: (1) A(2)(b) and B(2)(b) are cut at the interlobar fissure; (2) A(3)(a) and B(3)(a) are cut from the ventral side of hilum; (3) the peripheral stumps of A(3)(a) and B(3)(a) are transferred to the interlobar fissure; and (4) subsegments of S(3)(a) and S(2)(b) are resected with the peripheral stumps of A(2)(b), B(2)(b), A(3)(a), and B(3)(a) from the side of the interlobar fissure. We believe this procedure makes the combined resection of S(2)(b) and S(3)(a) easy.