title: Safe transection of aberrant arteries associated with pulmonary sequestrations.
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) lobectomy is increasingly used for pulmonary sequestration; however, there are few descriptions of safe handling of the aberrant artery. Here we clarify the safe handling of an aberrant artery using a clinical review and an experimental model.
  
  
  METHODS
  We retrospectively reviewed the records of patients who underwent lobectomy for pulmonary sequestration with aberrant arteries at the Nippon Medical School between January 2008 and December 2010. This was supplemented by an experimental pressure test using vessels obtained from pigs.
  
  
  RESULTS
  We identified four patients with aberrant arteries that were successfully occluded via either stapling. In the experimental model, we divided pig vessels into small-diameter (S) and large-diameter (L) groups. The 1.0-mm-high staples were stronger in the S group than in the L group (p = 0.028). In the L group, the 2.0-mm-high staples were stronger than the 1.0-mm staples (p = 0.015). Leakage from the staple line was associated with a poorer B-shape of inserted staples.
  
  
  CONCLUSIONS
  The techniques described in this report are useful in successful minimally invasive transection of an aberrant artery (other than very thin vessels) when resecting a pulmonary sequestration by stapler only. A detailed investigation should be performed to determine the most appropriate stapler or cartridge.
authors.affiliation: Department of Thoracic Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, 211-8533, Kanagawa, Japan. s3021@nms.ac.jp.|Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan. s3021@nms.ac.jp.
authors.forename: Junichi
authors.initials: J
authors.lastname: Okamoto
authors.affiliation: Department of Thoracic Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, 211-8533, Kanagawa, Japan.|Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Kubokura
authors.affiliation: Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Jitsuo
authors.initials: J
authors.lastname: Usuda
mesh_terms: D000818:Animals; D001158:Arteries / Q000601:surgery*; D001998:Bronchopulmonary Sequestration / Q000601:surgery*; D006801:Humans; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D013552:Swine; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*