Uniportal video-assisted thoracoscopic surgical (VATS) segmentectomy with preoperative dual localization: right upper lobe wedge resection and left upper lobe upper division segmentectomy.

Abstract

Clinical vignette A 75-year-old male presented with abnormalities upon chest computed tomography (CT) scanning at a routine check. He had a 1.7-cm sized ground glass opacity (GGO) on the posterior segment of the right upper lung (RUL) and a 1.2-cmsized semisolid lung nodule on the left upper lung (LUL). To differentiate synchronous metastasis, sequential CT-guided core biopsy was performed for the GGO lesion on the posterior segment of the RUL and the posterior segment of the LUL. Both lesions were suspected to be adenomatous hyperplasia or non-small cell lung cancer. Adenocarcinoma was detected in situ upon pathologic examination. A positron emission tomography (PET) scan showed no lymph node metastasis or extrathoracic distant metastasis. The LUL semisolid lesion showed mild hypermetabolism, while the RUL pure GGO lesion showed no definite uptake on PET scan. Pulmonary function was as follows: forced vital capacity (FVC), 3.07 L (75%); forced expiratory volume in 1 second (FEV1), 2.34 L (88%); carbon monoxide lung diffusion capacity (DLCO), 20.7 mL/mmHg/min (116%). The patient was referred for surgical resection of bilateral synchronous lung lesions. In this case, by employment of the dual localization technique (hook-wire and lipiodol), we performed bilateral uniportal video-assisted thoracoscopic surgery (VATS) resection. Wedge resection was carried out for the GGO lesion on the posterior segment of the RUL and left upper divisional segmentectomy was carried out for the semisolid lesion on