Uniportal video-assisted thoracoscopic right upper lobectomy and systemic mediastinal lymph nodes dissection

After over 20 years of improvements, video-assisted thoracoscopic surgery (VATS) has come to be accepted worldwide, becoming the standard approach for treating early lung cancer (1,2). In the trend towards minimally invasive thoracic surgical techniques, some surgeons have become dissatisfied with the 3 or 4 incisions used in conventional VATS lung cancer operations and have started to try single-incision approaches. Increasing numbers of studies have proved the feasibility and safety of uniportal VATS lobectomy (3,4), and its advantages are being researched. Several recent studies of uniportal VATS pulmonary resection reported reduction in postoperative pain and paresthesias and some other surgeons have even reported advantages such as improved geometry for instrumentation and exposure during surgery (5-8). Currently, uniportal VATS approaches performed at centers with experienced staff can allow wedge resection, lobectomy and radical mediastinal lymph node dissection (9,10), or even more difficult procedures like sleeve lobectomy. Once the uniportal vision angle, which is different from the conventional VATS angle, is well adapted, techniques and instruments are mastered, and good patient selection processes established, uniportal VATS approach may become an alternative to the conventional VATS for early-stage lung cancer (9,10). As shown in the operation video accompanied with this article, we are trying to demonstrate the uniportal VATS techniques of hilar anatomy, bronchus and blood vessels separation, mediastinal lymph node areas exploration and en-bloc dissection (Figure 1). In this article, we would also like to discuss our opinions regarding choosing between different telescopes, different staplers under uniportal approaches, and to explain our mediastinal lymph nodes dissection techniques