Anatomical segmentectomy under uniportal video-assisted thoracoscopic surgery for early staged non-small cell lung cancer: a case report

Abstract

Background: Anatomical segmentectomy has become more and more universal in thoracic surgery because of the increasing detection of pulmonary nodules with ground-glass opacity (GGO), most of which proved early staged non-small cell lung cancer (NSCLC) postoperative. With the advantage of preservation of normal lung tissues, segmentectomy may be performed by surgeons when computed tomography (CT) scan shows pure GGO or multiple GGOs appearing. Especially when the patients with poor cardiopulmonary function or severe comorbidities or in the circumstance of bilateral pulmonary GGOs, segmentectomy can provide opportunities to radically resect all lesions. With the development of minimally invasive surgery technology, uniportal video-assisted thoracoscopic surgery (VATS) has become the regular operative route in many medical centers because it can provide less access trauma, less stress response, less pain, shorter hospital stays, and a lower postoperative complication rate and corresponds well with the idea of "minimally invasive". However, all of the procedures must be performed in one tiny portal, so uniportal VATS anatomical segmentectomy not only needs the skill and patience of surgeons but the effective cooperation of assistants, nurses and anesthetists, and plenty of details must be paid special attention.Case Description: Here we present a video of a patient undergoing S 1 segmentectomy of right upper lobectomy (RUL) under uniportal VATS. The chief complaints of the patients was that two pure GGOs in the bilateral upper lobe were found by physical examination for 26 months and he had no symptoms. We performed S 1 segmentectomy of RUL under uniportal first time and performed trisegmentectomy of left upper lobectomy (LUL) 3 months later. With routinely follow-up, no evidence of relapse and metastasis disease was found. Conclusions:We think anatomical segmentectomy under uniportal VATS can be a feasible and safe procedure that reduces trauma and has equivalent oncology outcomes to lobectomy in early-stage lung cancer but need a more experienced medical center to perform.

Is a single port enough for the learned thoracic surgeons?

“…As reported in the international multidisciplinary team discussion titled "Anatomical segmentectomy under uniportal video-assisted thoracoscopic surgery (VATS) for early staged non-small cell lung cancer: a case report" by Wang et al (1), anatomical segmentectomy under uniportal VATS can be a feasible and safe minimally invasive procedure. The authors also concluded that uniportal segmentectomy has equivalent oncological outcomes to lobectomy for early-stage lung cancer but needs to be performed at an experienced medical center.…”

Beyond the limits: journey to feasible and safe uniportal VATS surgery for lung cancer

“…The article "Anatomical segmentectomy under uniportal video-assisted thoracoscopic surgery for early staged non-small cell lung cancer" clearly describes the issues mentioned above (9). The article consists of two parts, the first section shows how a surgeon can perform an uniportal segmentectomy, and the second section deals with the main issues in uniportal lung cancer surgery through interactive discussion.…”

Thoracoscopic anatomical segmentectomy for early-stage non-small cell lung cancer: minimally invasive surgery involving various approaches

“…In the case report by Wang et al (12), the uniportal videoassisted thoracoscopic segmentectomy was shown as a right apical (S1) segmentectomy and was relatively complex. This procedure is currently the most popular among minimally invasive surgeries, and the case report contained useful information that included the details of procedural steps, the understanding of the precise anatomies of pulmonary vasculatures and bronchi using a three-dimensional (3D) reconstruction, and the characteristics of uniportal videoassisted thoracoscopic surgery (VATS).…”

“…In addition, the patient described in the report by Wang et al (12) had other lung nodules at the same time and therefore needed a surgical strategy of resection planning for multiple nodules. We occasionally encounter cases with multiple small-sized GGO-dominant tumors, such as that of this patient.…”

“…Various technical aspects should be discussed in segmentectomies, such as the recognition of the intersegmental plane and the resection margins and lymph node (LN) biopsy as described in the discussion section of the report by Wang et al (12). The number of reports aiming to address these issues has also increased in recent years.…”