Uniportal VATS Left Upper Lobe Cancer Fissureless Technique.

Left upper lobectomy is the most difficult resection to perform by uniportal VATS, especially when an incomplete oblique fissure is found or there are silicotic lymph nodes around the hilar structures. We present a video of an uniportal VATS left upper lobectomy with a complex oblique fissure. We used the uniportal VATS set as recommended by Diego Gonzalez Rivas.
A 72 year-old male was admitted to our department for a left upper lobe (LUL) mass surgery. A PET-CT scan revealed a 3 cm mass in the LUL with no lymph node affection. The patient was proposed for uniportal VATS surgery.A VATS approach through a single 4 cm incision was made. Emphysematous lung and an oblique incomplete fissure was found (lingula was in contact with the diaphragm). The trunkus anterior and vein were divided by using staplers and small branches were divided with vascular clips. The bronchus and lingular artery were surrounded by fixed silicotic lymph nodes so the strategy was to divide the anterior portion of the fissure once the basal artery was identified. The lingular artery was stapled and the bronchus was divided as the last step of the procedure.
The total surgical time was 120 minutes. The patient was discharged home on the second postoperative day. The pathological examination revealed a squamous carcinoma with no lymph involvement. Video by Diego Gonzalez-Rivas, MD.