First Uniportal VATS Sleeve Lobectomy Case in Turkey

Abstract

Introduction: In recent years, VATS (Video-assisted thoracic surgery) has become the gold standard approach in the surgical treatment of early-stage Non-small Cell Lung Cancer. In August 2022, we presented the first case of Uniportal VATS right bronchial sleeve upper lobectomy for right main bronchial invasion, which was successfully managed following oncologic principles and reported in our country. Case: A patient who had been in remission for five years with a diagnosis of laryngeal carcinoma complained of cough. Computed thoracic tomography showed hilar peribronchial thickening and an endobronchial lesion extending from the right upper lobe bronchus to the main bronchus, almost completely obstructing the upper lobe bronchus. Bronchoscopic biopsy was reported as squamous cell carcinoma.The thorax was entered through an approximately 3 cm incision in the right fifth intercostal space. Firstly, the right upper lobe pulmonary arteries and superior pulmonary vein were dissected and cut. The main bronchus was divided until the intermediate bronchus. With the help of endoscissor, the main and intermediate bronchus were incised with appropriate surgical margins, and the lobectomy material was removed.The mediastinal pleura was opened, and lymph nodes 7, 9, 10 were dissected. Before anastomosis, the azygos vein was turned and fixed to the chest wall with a tying suture, and the azygos vein was removed from the anastomosis line, and appropriate exposure was provided. One suture was passed through the lateral cartilage from the inside out, and the needle was fixed to the posterior pleura. Membranous and cartilage parts were continuously anastomosed with double-needle 3/0 prolene suture at 2-3 mm intervals. Pathological evaluation was reported as squamous cell carcinoma, hilar 1/11 lymph node metastasis, and negative surgical margin. Conclusion: Adhering to oncologic principles, sleeve resections, which are difficult even with the currently known open techniques, can be performed effectively and safely with uniportal VATS in experienced centers