Uniportal VATS right apical segmentectomy (S1): a case report and the surgical technique

Lobectomy has long been considered the standard procedure for early-stage non-small cell lung cancer. However, the interest in sub-lobar resections (i.e., segmentectomy) is increasing. Especially to be applied in patients with small tumors and marginal cardiopulmonary function. Yet, performing a segmentectomy through video-assisted thoracoscopic surgery (VATS) may be technically challenging, and even more challenging if performed through a uniportal approach. The objective of the current study is to describe and visualize the surgical technique of uniportal thoracoscopic segmentectomy by means of a case report. We present the case of a 58-year-old female in whom 18F-deoxyglucose positron emission tomography (FDG-PET)-computed tomography (CT) showed a 17-millimeter metabolically active lesion in segment 1 (S1; cTNM, cT1bN0M0 stage IA2). The patient was scheduled for a uniportal VATS right apical segmentectomy of S1 with additional mediastinal lymph node resection. The case and surgical technique were described and visualized. The surgical steps included adhesiolysis, dissection of the hilar structures, exposure and subsequent stapling of the A1 and V1a branch, exposure of the B1 bronchus branch and confirming exclusion of B1 prior to stapling, marking of the intersegmental planes with the use of indocyanine green and near-infrared fluorescence, stapling of the intersegmental parenchyma and an additional mediastinal lymph node resection. The recovery was uneventful.