Uniportal video-assisted thoracoscopic right upper sleeve lobectomy
Original Article on Thoracic Surgery

Uniportal video-assisted thoracoscopic right upper sleeve lobectomy

William Guido1, Diego Gonzalez-Rivas2,3, Liang Duang3, Yang Yang3, Wentao Li3, Gening Jiang3

1Department of Thoracic Surgery, Rafael Angel Calderon Guardia Hospital, San José, Costa Rica; 2Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain; 3Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China

Contributions: (I) Conception and design: D Gonzalez-Rivas, W Guido; (II) Administrative support: W Guido; (III) Provision of study materials or patients: Y Yang; (IV) Collection and assembly of data: G Jiang, L Duang, W Lee; (V) Data analysis and interpretation: Y Yang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Diego Gonzalez-Rivas. Department of Thoracic Surgery, Coruña University Hospital, Xubias 84, 15006 Coruña, Spain. Email: diego.gonzalez.rivas@sergas.es.

Background: The development of minimally invasive thoracic surgery in recent years is undeniable, VATS has evolved from the conventional three-port technique to an uniportal approach, without compromising the type of cases that can be operated successfully.

Methods: Thanks to the continuous progress of uniportal video-assisted thoracoscopic surgery (VATS) the complexity of cases performed by this approach has improved remarkably since the first procedures were made, recent advances in surgical thoracoscopic technology had made feasible to achieve vascular and bronchial sleeve lobectomies. Anatomic variants in patients can increase the technical difficulty of the procedure making the process more challenging.

Results: In this case the sleeve right upper lobectomy was performed by uniportal VATS despite the obstruction of the right pulmonary artery (PA) for the bronchial anastomosis.

Conclusions: In the hands of experienced surgeons in uniportal VATS with background in thoracoscopic suturing, sleeve lobectomies are feasible and safe to perform even when anatomic variants increase the complexity of the case.

Keywords: Sleeve lobectomy; bronchoplasty; uniportal video-assisted thoracoscopic surgery (VATS); bronchial resection; lobectomy

Received: 20 July 2015; Accepted: 21 July 2015; Published: 07 August 2015.

doi: 10.3978/j.issn.2221-2965.2015.07.05

Minimally invasive surgery for cancer patients has proven to offer many benefits over traditional surgery, including less pain, faster recovery and better cosmesis, without compromising oncologic results (1,2).

Video-assisted thoracoscopic surgery (VATS) is the representation of this concept in thoracic surgery and it has evolved from the conventional three port technique to the uniportal approach (2).

Uniportal VATS follows the same principles of coordination as in open surgery, since the camera is usually placed at the posterior part of the incision and the instruments performing the procedure are always bellow, mimicking the eye-hand position and coordination of open surgery (3).

This technique has improved substantially since the first reports of major lung resections were reported in 2011 (4,5) to advances cases (6) and more complex resections such a sleeve and double sleeve lobectomies in recent days (7,8). With the development of high definition cameras, energy devices, articulating instruments and the growing experience of surgeons performing this technique almost any major lung resection and reconstruction procedure can be done with this technique.

Sleeve lobectomies are among the most complex cases in thoracic surgery, even in open surgery these cases are usually challenging for thoracic surgeons (9,10).

Thanks to the rapid progress of uniportal VATS, complex procedures such as bronchial and vascular reconstruction can be perform safely in the hands of expert surgeons.

Although there are a several reports of thoracoscopic sleeve lobectomies, only a few of them are performed by using only one incision (11).

This video shows a complex case of a sleeve right upper lobectomy performed by uniportal VATS (Figure 1). This surgery was specially difficult because the right pulmonary artery (PA) was almost over the location in which the bronchial anastomosis was performed, making the procedure particularly challenging. The PA was initially retracted and taped, allowing a better visualization of the divided bronchus. The anastomosis was performed using a 3/0 polydioxanone (PDS) suture, with continuous suture in the membranous portion and also for the cartilaginous part.

Figure 1 Uniportal video-assisted thoracoscopic right upper sleeve lobectomy (12). This video shows a complex case of a sleeve right upper lobectomy performed by uniportal VATS. VATS, video-assisted thoracoscopic surgery. Available online: http://www.asvide.com/articles/618

The direct view that uniportal VATS provides makes feasible and safe to perform complex maneuvers such as bronchial suturing even when there are anatomic conditions that blocks the working field, such as the PA in this case.

Only VATS surgeons with experience in thoracoscopic suturing should attempt this kind of cases in order to perform a safe anastomosis and minimize the risk of complications during surgery and in the postoperative setting.




Conflicts of Interest: The authors have no conflicts of interest to declare.

Informed Consent: Written informed consent was obtained from the patient. A copy of the written consent is available for review by the Editor-in-Chief of this journal.


  1. Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 2009;27:2553-62. [PubMed]
  2. Kaseda S, Aoki T, Hangai N, et al. Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg 2000;70:1644-6. [PubMed]
  3. Gonzalez D, de la Torre M, Paradela M, et al. Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases. Eur J Cardiothorac Surg 2011;40:e21-8. [PubMed]
  4. Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg 2011;12:514-5. [PubMed]
  5. Gonzalez-Rivas D, Paradela M, Fernandez R, et al. Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Ann Thorac Surg 2013;95:426-32. [PubMed]
  6. Gonzalez-Rivas D, Fieira E, Delgado M, et al. Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small cell lung cancer? J Thorac Dis 2014;6:641-8. [PubMed]
  7. Gonzalez-Rivas D, Fernandez R, Fieira E, et al. Uniportal video-assisted thoracoscopic bronchial sleeve lobectomy: first report. J Thorac Cardiovasc Surg 2013;145:1676-7. [PubMed]
  8. Gonzalez-Rivas D, Delgado M, Fieira E, et al. Double sleeve uniportal video-assisted thoracoscopic lobectomy for non-small cell lung cancer. Ann Cardiothorac Surg 2014;3:E2. [PubMed]
  9. Bagan P, Le Pimpec-Barthes F, Badia A, et al. Bronchial sleeve resections: lung function resurrecting procedure. Eur J Cardiothorac Surg 2008;34:484-7. [PubMed]
  10. Ng CS. Thoracoscopic sleeve resection-the better approach? J Thorac Dis 2014;6:1164-6. [PubMed]
  11. Gonzalez-Rivas D, Fieira E, Delgado M, et al. Uniportal video-assisted thoracoscopic sleeve lobectomy and other complex resections. J Thorac Dis 2014;6:S674-81. [PubMed]
  12. Guido W, Gonzalez-Rivas D, Duang L, et al. Uniportal video-assisted thoracoscopic right upper sleeve lobectomy. Asvide 2015;2:071. Available online: http://www.asvide.com/articles/618
doi: 10.3978/j.issn.2221-2965.2015.07.05
Cite this article as: Guido W, Gonzalez-Rivas D, Duang L, Yang Y, Li W, Jiang G. Uniportal video-assisted thoracoscopic right upper sleeve lobectomy. J Vis Surg 2015;1:10.