Perimammary uniportal vats fissureless right anterior segmentectomy for lung metastasectomy: a case report

Abstract

: Secondary lung cancer is frequently witnessed in practice. Surgical resection is considered an essential approach in managing pulmonary metastases, with open or video-assisted thoracoscopic surgery (VATS) lobectomy typically preferred for centrally located metastasis. On the other hand, uniportal VATS anatomical segmentectomy provides an excellent lung parenchyma sparing technique to prevent the lobectomy, but it is challenging and demands strong skills in VATS. Therefore, we present a novel approach for uniportal VATS segmentectomy based on a vertical and curved utility incision performed in the perimammary fold of a 58-year-old female with a known case of colorectal cancer presented with a solitary lung metastasis located in the right anterior segment. The patient underwent, for the first time, a successful right perimammary uniportal VATS fissureless anterior segmentectomy. She experienced low postoperative pain, being the average postoperative pain (EVA scale) ± SD (0.466±0.9), and was discharged on the second postoperative day. Free margin was achieved and no recurrence has been observed within the last 20 months of follow-up. The patient is highly satisfied with the long-term cosmetic result due to a less-visible scar. In conclusion, the perimammary uniportal approach provides, low pain, short length hospital stay and an excellent cosmetic outcome. Further studies are required to prove the benefits of the perimammary approach.