Key Points

• Thorough understanding of the anatomic patterns of the airways, pulmonary arteries, veins, and lymphatics is essential for all forms of lung surgery.
• Airways, pulmonary arteries, and bronchial arteries run together in the center of the bronchopulmonary segments; pulmonary veins run in the periphery and intersegmental planes.
• Variations of both large and microscopic structures are common; the airway anatomy is the most constant and pulmonary venous anatomy is the most varied.
• Pulmonary lymphatics are found in both the peripheral and central parts of the segments. Lymphatic drainage patterns from each lobe are generally predictable, and evaluation of lymph node metastases gives essential prognostic information for patients with non-small cell lung cancer.
• Locations of pulmonary lymph nodes act as intraoperative landmarks, aiding in the identification of other pulmonary structures during lung resection.
• Knowledge of anatomic relationships in the hilum is the key to successful pulmonary surgery.