The uniportal approach for major pulmonary resections began in 2010, with the first case being reported by D González-Rivas and colleagues in La Coruña, Spain. Since then, in different countries, thoracic surgeons had been performing hundreds of cases, with more advanced and complex procedures. Nowadays, there are reports of uniportal tracheal resection and reconstruction, carinal resection, bronchoplastic procedures, lobectomies with chest wall excision, and vascular reconstruction with optimal outcomes. The development of technologies and the potential benefits of a direct view, anatomic instrumentation, better cosmesis, and, potentially, less postoperative pain have led uniportal video-assisted thoracic surgery to grow exponentially worldwide.

Surgical treatment for non-small cell lung cancer (NSCLC) involving trachea and carina is one of the most infrequent and challenging procedures for a thoracic surgeon, requiring careful preoperative assessment, high level management of the airway, advanced surgical technique and appropriate postoperative care. Carinal and tracheal resections with lung sparing, and carinal sleeve pneumonectomy are part of these complex techniques, with a variable rate of morbidity and mortality. To prevent complications, the most important aspect of the technique is for reconstruction to be performed without tension and with a good blood supply. If a complication is suspected, it must be diagnosed at an early stage, and the problem must be handled aggressively to avoid further progression. The majority of cases are performed with an open approach, but under the care of surgeons and anesthesiologists experienced in minimally invasive thoracic procedures, with advanced airway management skills, in high volume referral centers, these procedures can be performed safely with video-assisted thoracic surgery to obtain good postoperative results. In recent years, with the rapid development of uniportal video assisted thoracic surgery (VATS), this approach resulted in shorter postoperative stays, less postoperative pain and faster recovery after surgery, maintaining oncological principles, becoming an excellent alternative for these difficult cases. This article aims to review the specific considerations that involve this kind of tumors, surgical technique and anesthesiology options, and the recent shift to a minimally invasive approach.

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Bolaños-Cubillo A. Minimally invasive thoracic surgery in lung cancer: respecting oncologic principles is the key. Ann Transl

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