Thoracoscopic left apicoposterior segmentectomy for bronchiectasis with a displaced B¹⁺² bronchus: a case report.

backgroundThe coexistence of bronchial anatomical variations with bronchiectasis presents significant challenges for surgical intervention. Among these, an anomalous left apicoposterior segmental bronchus (B¹⁺²)—originating ectopically from the left main bronchus—is a highly uncommon variant that predisposes individuals to impaired mucociliary clearance and subsequent bronchiectasis. This case demonstrates the technical feasibility and considerations of performing a video- assisted thoracoscopic surgery (VATS) left apicoposterior segmentectomy in the presence of an displaced B1 + 2 bronchus, a rare anatomic variant that adds complexity to surgical planning. CASE PRESENTATION: A 41-year-old male was admitted with a history of recurrent cough and purulent sputum. High-resolution computed tomography (HRCT) of the chest revealed localized cystic bronchiectasis with marked bronchial wall thickening in the left upper lobe apicoposterior segment. Preoperative three-dimensional computed tomography (3D-CT) reconstruction further identified an anatomical variation: the B¹⁺² bronchus originated directly from the left main bronchus, deviating from the conventional segmental branching pattern. Additionally, fusion was observed between the dorsal segment of the left lower lobe and the apicoposterior segment, further complicating the anatomical landscape. During video-assisted thoracoscopic surgery (VATS), the ectopic B¹⁺² bronchus and its accompanying arterial branch (A¹⁺²) were carefully dissected and transected via a posterior mediastinal pleural approach. The inflation-deflation technique was subsequently applied to delineate the intersegmental plane—a crucial step that enabled precise anatomical division under full thoracoscopic guidance. The total operative time was 115 min, with an estimated blood loss of 50 mL. The patient’s postoperative recovery was uneventful, and he was discharged on postoperative day 3. Histopathological examination confirmed the diagnosis of focal bronchiectasis with chronic inflammatory changes. No recurrence was observed at the six-month follow-up.

conclusionsIn patients with bronchiectasis and a displaced B1+ 2 bronchus, preoperative 3D-CT reconstruction enables accurate delineation of complex anatomy and facilitates surgical planning (e.g., favoring a posterior mediastinal approach). The inflation-deflation technique effectively identifies the intersegmental plane. Together, these strategies are essential for achieving safe and precise thoracoscopic apicoposterior segmentectomy. This case offers a valuable reference for performing anatomical segmentectomy in patients with bronchial ectopia and benign lung disease.