{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T12:36:21Z","timestamp":1762950981609,"version":"3.45.0"},"reference-count":0,"publisher":"European Association of Cardiothoracic Surgery (EACTS Publishing Ltd)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MMCTS"],"published-print":{"date-parts":[[2025,11,12]]},"abstract":"<jats:p>Pre-operative planning is crucial before minimally invasive lung resection. 3D reconstruction software has become an essential tool to identify anatomical variations and anticipate surgical difficulties. Nevertheless, a misinterpretation can make surgery more challenging, especially in the presence of anatomical anomalies such as a cleft left upper lobe. A 74-year-old woman was treated for an adenocarcinoma in the left upper lobe. Multidisciplinary discussion recommended robotic assisted left upper lobectomy. At first, pre-operative 3D reconstruction showed no anomalies. Intra-operatively, dissection revealed an unusual culmen bronchus (B1+3) arising posterior to the pulmonary artery trunk, so-called \u201ccleft\u201d left upper lobe or \u201ceparterial\u201d bronchus. This lesser-known variant had not been identified pre-operatively by automated software, creating temporary intra-operative uncertainty. The dissection was adapted, and lobectomy was successfully completed. A retrospective analysis of the 3D model made it possible to understand the error and to better appreciate the anatomical relationships of this bronchus. The post-operative course was uneventful and at 8-month follow-up the patient remained recurrence-free. This case highlights the importance of pre-operative imaging analysis, the limitations of automated 3D reconstruction, and the need for surgeon awareness of rare bronchial variants to ensure efficiency during minimally invasive surgery.<\/jats:p>","DOI":"10.1510\/mmcts.2025.123","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T12:32:27Z","timestamp":1762950747000},"source":"Crossref","is-referenced-by-count":0,"title":["Missed retro-arterial (eparterial) bronchus in automated 3D modelling during robotic left upper lobectomy"],"prefix":"10.1510","member":"10966","published-online":{"date-parts":[[2025,11,12]]},"container-title":["Multimedia Manual of Cardio-Thoracic Surgery"],"original-title":[],"deposited":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T12:32:27Z","timestamp":1762950747000},"score":1,"resource":{"primary":{"URL":"https:\/\/mmcts.org\/case-report\/2120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,12]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1510\/mmcts.2025.123","relation":{},"ISSN":["1813-9175"],"issn-type":[{"value":"1813-9175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,12]]}}}