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Dharmaraj et al. Mini-invasive Surg 2020;4:65 I http://dx.doi.org/10.20517/2574-1225.2020.51 Page 5 of 6
[2]
[6]
primary lung malignancy . Yurugi et al. were the first to report a case of VATS right upper lobectomy
[1]
for lung cancer with tracheal bronchus, utilizing a 5-port technique. Huang et al. were the first to report
a case of uniportal right VATS upper lobectomy for lung cancer associated with tracheal bronchus. To
date, this is the first case report from Malaysia, and to the authors’ best knowledge, the second case report
internationally, of a patient with primary lung carcinoma, with a tracheal bronchus, to have undergone
right upper lobectomy via uniportal VATS.

Variations in bronchovascular patterns are common, hence it is important for a thoracic surgeon to look out
for these variations, both pre- and intra-operatively, in order to prevent devastating outcomes. In a study by
[13]
Nagashima et al. , bronchovascular patterns of the right upper lobes of 263 patients were reviewed using
3D CT angiography and bronchography images. Based on their study, 71.9% (189 patients) had the usual
pulmonary artery branching, and 44.1% (116 patients) had the usual upper lobe bronchial branching, as
[13]
classically described in most textbooks . The remaining patients had variations in bronchovascular supply
to the right upper lobe. In 13.3% of patients, the origin of A1 and A3 varied, as in the subject of this case
report.

In conclusion, primary lung carcinoma with associated tracheal brochus is rare. A myriad of other
bronchovascular variations exists, with or without an associated tracheal bronchus. It is imperative for
thoracic surgeons to have thorough knowledge on bronchovascular pattern variations, and to perform
thorough dissection during surgery in order to avoid devastating outcomes. In the hands of an experienced
surgeon, with detailed preoperative planning, uniportal VATS lobectomy can be safely performed with
good outcomes and low morbidity.

DECLARATIONS
Authors’ contributions
Collected and selected articles: Dharmaraj B
Participated in manuscript, writing and review: Dharmaraj B, Sathiamurthy N, Diong NC, Balasubbiah N
Participated in review: Dharmaraj B, Sathiamurthy N

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Approval obtained from the office of the Director and the hospitals’ ethics committee to proceed with this
analysis and publication.

Consent for publication
The author(s) declared that informed consent has been taken from the patient for usage of peri-operative
data and images for publication purpose.

Copyright
© The Author(s) 2020.