Minimally Invasive Resection of Intralobar Pulmonary Sequestration Following Same-Day Interventional Radiological Embolisation of the Feeding Vessel: A Case Series From a Single Tertiary Centre

Pulmonary sequestration (PS) is a congenital abnormality of the lung where a region of pulmonary parenchymal tissue is supplied by an aberrant systemic artery, which may arise from the thoracic aorta, abdominal aorta, celiac trunk, or intercostal arteries. They are further sub-classified as intralobar or extralobar, depending on whether the sequestered lung has an independent visceral pleural covering. Hybrid minimally invasive treatment of intralobar PS with preoperative embolisation of feeding vessels followed by video-assisted thoracoscopic surgery (VATS) resection has become more widespread in recent years due to increased access to interventional radiology. Embolisation of the feeding vessel is thought to reduce the risk of haemorrhage, which can occur with traction of the delicate feeding vessel wall during VATS. Here, we present a series of four cases of intralobar sequestration treated by a hybrid minimally invasive approach at our centre from 2021 to 2024. These included three sequestrations with a feeding artery arising from the descending thoracic aorta and one with a feeding vessel arising from the proximal celiac trunk. Each patient underwent interventional radiological (IR) embolisation of the feeding vessel on the morning of surgery, with identification of the vessel by preoperative computed tomography (CT). Two resections were done by a VATS approach, and two others via mini thoracotomy. Ligation of aberrant vessels was done with Endo GIA™ stapler (Medtronic, Minneapolis, MN). The procedure was generally well tolerated, with complications including serous drainage from surgical wounds in two cases. A hybrid minimally invasive approach was implemented successfully in our unit with good outcomes for all four patients. With thorough preoperative planning and cooperation between radiology and surgical units, preoperative embolisation can allow for less invasive thoracic surgery, faster recovery and better outcomes for patients with intralobar PS.