title: Hybrid video-assisted thoracoscopic surgery lobectomy of fissureless congenital cystic adenomatoid malformation: a case report.
abstract: BACKGROUND
  Thoracoscopic lobectomy for congenital pulmonary airway malformation has been indicated from the neonatal period to adolescence. However, it is difficult to approach the pulmonary artery for lobectomy in congenital lung malformations with incomplete or absent interlobar fissures. Multidetector computed tomographic images and computed tomography pulmonary angiography gave us helpful information before the operation. We performed thoracoscopic lobectomy for congenital pulmonary airway malformations with absent interlobar fissures and adhesions in accordance with information from multidetector computed tomographic images.
  
  
  METHODS
  A 14-year-old Japanese girl received a diagnosis of congenital pulmonary airway malformation when she presented with pneumonia. Using multidetector computed tomography and three-dimensional reconstruction provides meticulous characterization of the anatomy in pediatric patients. We confirmed that her left A4+5 artery arose from her left pulmonary artery medial to A6. Her left pulmonary artery was divided just proximal to the A6 origin before the lobes were separated safely. We took advantage of using a stapler to divide the fissureless thick parenchyma. Perioperative diagnosis was congenital cystic adenomatoid malformation.
  
  
  CONCLUSIONS
  We used preoperative multidetector computed tomography to outline the bronchovascular anatomy and guide hybrid video-assisted thoracoscopic surgery for a congenital cystic adenomatoid malformation in a fissureless left lung.
authors: Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan. mitchinakachi@gmail.com.
authors: Mitsuyuki
authors: M
authors: Nakata
authors: Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan. s-yoshida@faculty.chiba-u.jp.
authors: Shigetoshi
authors: S
authors: Yoshida
authors: Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan. takk@faculty.chiba-u.jp.
authors: Takeshi
authors: T
authors: Saito
authors: Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan. kta@cc.rim.or.jp.
authors: Keita
authors: K
authors: Terui
authors: Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan. mitsutetsu@gmail.com.
authors: Tetsuya
authors: T
authors: Mitsunaga
authors: Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan. sachieono26@gmail.com.
authors: Sachie
authors: S
authors: Ohno
authors: Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan. misecchi@hotmail.com.
authors: Naoko
authors: N
authors: Mise
authors: Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan. z5m1019@gmail.com.
authors: Satoru
authors: S
authors: Oita
authors: Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan. yoshita@faculty.chiba-u.jp.
authors: Hideo
authors: H
authors: Yoshida
mesh_terms: D000293:Adolescent; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000601:surgery; D061330:Multidetector Computed Tomography; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*
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