Subxiphoid Uniportal Middle Lobectomy and Anatomic Anterior Segmentectomy (S3)

 The video-assisted thoracoscopic (VATS) approach for combined lobectomy and segmentectomy is an infrequent procedure, rarely reported in the literature. There is no doubt that video-assisted thoracoscopic surgery (VATS) is currently a better choice than thoracotomy for segmentectomies. However, anatomical segmental resections are more demanding procedures because they require a better knowledge of the distal lung anatomy. These lung sparing procedures are usually indicated for deeply located benign lesions, metastasis or early stage lung cancer such as ground glass opacities (GGO). Several studies recently published have shown that segmentectomies can be performed safely without compromising oncologic results in this group of patients.

Most of the surgeons doing segmentectomies implement a thoracoscopic approach through a transthoracic utility incision of 4-6 cm, with one to three additional ports in different positions. However, the anatomic resection can be performed by opening only one intercostal space, through a single utility incision. Since 2011, when the first uniportal VATS lobectomy was published, the single incision technique has been stablished as the approach of choice in many thoracic departments all over the world. Since then, a growing number of articles are available in the literature showing the feasibility, safety and good outcomes of this procedure for major pulmonary resections. Recently the aim to avoid the intercostal nerve damage created by the transthoracic ports or by the utility incision has led to the creation of a novel procedure described in 2014 for lobectomy through a single subxiphoid incision. Here we report an unusual case of a lobectomy combined with anatomic segmentectomy performed through a uniportal subxiphoid approach.