Video-assisted thoracic surgery upper lobe trisegmentectomy for early-stage left apical lung cancer

Resection of the left upper lobe with preservation of the lingula is the anatomic equivalent of a right upper lobectomy with preservation of the right middle lobe. Therefore, our standard operation for a small apical tumor in the left upper lobe has been an apical trisegmentectomy. The purpose of this article is to review our experience with the procedure by video-assisted thoracic surgery (VATS) and to describe the operative technique for a VATS apical trisegmentectomy. Eleven patients underwent the procedure with no deaths, low morbidity, and good initial disease-free survival. A VATS apical trisegmentectomy seems to be a feasible and reasonable treatment for small stage I lung cancers at the apex of the left upper lobe.