Uniportal Video-Assisted Thoracoscopic Right Upper Lobectomy

Minimally invasive surgery (MIS) is gradually becoming the standard of care for the surgical treatment of nonsmall cell lung cancer (NSCLC). Compared with the multiple incision approach, including conventional multiportal video-assisted thoracoscopic surgery (mVATS) and multiportal robotic-assisted thoracoscopic surgery (mRATS), uniportal video-assisted thoracoscopic surgery (uVATS) offers a range of potential benefits such as straight target view from a sagittal plane, better lung exposure, ergonomic instrumentation, reduced postoperative pain, faster recovery, shorter length of hospital stay, and earlier administration of adjuvant therapy when necessary. However, uVATS remains a challenging procedure since all instrumentation shares the same access incision along the videothoracoscope. The learning curve demands a profound knowledge of specific technical details and comfort with specialized equipment to avoid intraoperative complications, essentially vascular accidents. This article provides a step-by-step description of uVATS right upper lobectomy, reviewing practical tips and tricks about operating room set-up, incision strategy, instrumentation management and operative sequence applied to the fissureless technique. This surgical technique is based on the author's preference and experience and therefore should not be taken as the only valid option. Our purpose is to make uVATS surgery accessible for most surgeons in their daily practice.