Segmental pneumonectomy is considered the recommended surgical approach for patients with small peripheral non-small cell lung cancer [1]. Prior to the operation, it is crucial for thoracic surgeons to have a thorough understanding of the anatomical structure of the pulmonary segment. Minics three-dimensional reconstruction technology can be employed to reconstruct the bronchi and blood vessels from chest CT images, enabling surgeons to visualize the anatomical structure and variations of lung segments from multiple perspectives. As a result, performing anatomical segmental pneumonectomy and conducting three-dimensional reconstruction of blood vessels and trachea prior to the operation becomes highly necessary.

A 47-year-old woman discovered a ground glass nodule(GGN) measuring approximately 8 mm in the right upper lobe(RUL) during a chest CT scan at our hospital over 3 years ago (Figs. 1, 2, 3, 4, 5). Throughout regular follow-up, no significant changes were observed in the nodule located in the right upper lobe. On July 19, 2023, a subsequent chest CT scan revealed that the nodule had increased in size by 10 mm and was hospitalized in our hospital on August 13,2023. Three-dimensional reconstruction of the chest prior to the operation displayed various variations in the bronchus and blood vessels: (1)the anterior bronchus originated from the right middle lung bronchus; (2) A3b and A5 shared a trunk; (3) A3a originated from the right inferior pulmonary trunk; (4) A1a and A2 shared a trunk; (5) A4 originated from the right basilar artery;(6)the right upper pulmonary arteries shared a trunk without a posterior ascending artery ; (7) The apical segmental vein and posterior segmental vein merge into the right pulmonary vein, while the anterior segmental vein solely drains into the right pulmonary vein. Based on the three-dimensional reconstruction, the nodule was identified in apical segmental(S1), and after conducting relevant examinations, the contraindication for surgery was ruled out.

The preoperative chest computed tomography (CT) scan revealed a ground glass nodule (GGN) measuring 10 mm in diameter, located near the pleura of the right upper lobe

After dissecting the upper hilar pleura, we isolated the apical subsegmental artery (A1a) and anterior subsegmental artery (A1b). However, we did not observe the recurrent artery (Rec.A2 )

Following the resection of the arteries and peribronchial lymph nodes, a three-dimensional reconstruction technique was employed to visualize the apical segmental bronchus (B1) and posterior segmental bronchus (B2). However, the anterior bronchus (B3) was not located

According to the three-dimensional reconstruction, it can be observed that the apical segmental vein (V1) and the posterior segmental vein (V2) merge into the right pulmonary vein, while the anterior segmental vein (V3) drains solely into the right pulmonary vein

Utilizing three-dimensional reconstruction technology, it is evident that the nodule is situated in the S1 region, with an ample margin available for a safe S1 resection

S1 Segmentectomy of the right upper lung using thoracoscopic approach was accurately executed following thorough preoperative planning based on chest reconstruction in three dimensions. Initially, the pleura and hilum of the anterior mediastinum were incised, and the sections A1a and A1b were dissected and extracted. No branch of the anterior segmental artery (A3) was detected within the first branch of the right pulmonary artery trunk. Subsequently, separation of the first branch of the right lung trachea was conducted, and identification of the apical segmental bronchus (B1) and posterior segmental bronchus (B2) occurred, while B3 was not located. B1 was liberated and excised. Ultimately, the apical segmental of the right upper lung was successfully excised, and intraoperative analysis of frozen tissue confirmed the presence of micro-invasive adenocarcinoma, while sampling of lymph nodes was performed. The patient experienced an uneventful recovery and was discharged on the fifth day postoperatively. The postoperative histopathological examination confirmed the diagnosis of minimal invasive adenocarcinoma of the lung with no involvement of the surrounding lymph nodes.