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

Guan Wang; Zhanwu Yu; Jijia Li; Wei Chen; Tianyi Ji; Hideki Ujiie; Motoki Yano; Hongxu Liu

doi:10.21037/jtd-21-1624

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

J Thorac Dis. 2022 Sep;14(9):3613-3623. doi: 10.21037/jtd-21-1624.

Authors

Guan Wang¹, Zhanwu Yu¹, Jijia Li¹, Wei Chen¹, Tianyi Ji², Hideki Ujiie³, Motoki Yano⁴, Hongxu Liu¹

Affiliations

¹ Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China.
² College of Acupuncture and Tuina, Liaoning University of Traditional Chinese Medicine, Shenyang, China.
³ Department of Cardiovascular and Thoracic Surgery, Hokkaido University, Hokkaido, Japan.
⁴ Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan.

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 S¹ 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 S¹ 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.

Keywords: Uniportal video-assisted thoracoscopic surgery (uniportal VATS); segmentectomy; non-small cell lung cancer (NSCLC); case report.

Publication types

Case Reports