Abstract
Background
Major vascular complications during video-assisted thoracoscopic surgery (VATS) are uncommon, and complete transection of a non-target pulmonary vein by an endoscopic stapler is exceedingly rare. When venous drainage of a preserved lobe is abruptly interrupted, rapid pulmonary congestion and life-threatening complications may ensue. Optimal management is particularly challenging when direct reconstruction is not technically feasible and additional lung resection is poorly tolerated.Case presentation
A 76-year-old man with left lower lobe lung cancer and moderate-to-severe obstructive ventilatory dysfunction underwent thoracoscopic resection, during which the left superior pulmonary vein was inadvertently completely transected. The left upper lobe became progressively congested. Because the proximal stump was only 3-5 mm long and located adjacent to the left atrium, direct reanastomosis was not possible. Additional left upper lobectomy, combined with the planned lower lobe resection, would have effectively amounted to left pneumonectomy. After conversion to thoracotomy, an autologous pericardial patch was fashioned into a tubular conduit and used to reconstruct the transected vein. The planned lobectomy was modified to extended S7 + 8 segmentectomy to preserve pulmonary function. Postoperative imaging showed no obvious residual congestion and satisfactory perfusion of the remaining left lung; however, conduit patency was not directly confirmed radiologically but was inferred from these favorable imaging findings and the absence of clinical signs of venous obstruction. Follow-up CT at approximately 3 months demonstrated significant resolution of pulmonary exudative lesions with no evidence of recurrent venous congestion.Conclusions
Autologous pericardial conduit reconstruction may provide an effective salvage strategy for inadvertent pulmonary vein transection during VATS when standard repair is not feasible. Combined with parenchymal-sparing resection, this approach may be particularly valuable in patients with limited pulmonary reserve. However, conduit patency in this case was confirmed only indirectly, and long-term durability remains to be established.