A "reverse direction" technique of single-port left upper pulmonary resection

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Techniques

Background:

• Single-port video-assisted thoracoscopic surgery (VATS) left upper lobectomy presents significant challenges.
• Previous approaches were limited by stapler angulation difficulties, particularly for upper lobes.
• The first single-port VATS left upper lobectomy was reported in 2011.

Purpose of the Study:

• To introduce and evaluate a novel "reverse direction" technique for single-port VATS left upper lobectomy.
• To address the technical difficulties associated with single-port access to the left upper lobe.

Main Methods:

• A new "reverse direction" technique for single-port VATS left upper lobectomy is described.
• The procedure involves dividing the apical-anterior arterial trunk and upper vein last.
• The sequence includes posterior artery, lingular artery, bronchus, and finally the upper vein & apical-anterior arterial trunk.

Main Results:

• The "reverse direction" technique overcomes angular limitations common in single-port VATS.
• It reduces the risk of pulmonary artery injury.
• It expands indications for single-port left upper lobe (LUL) resection, including hypoplastic lung fissures.

Conclusions:

• The "reverse direction" technique for single-port left upper pulmonary resection is feasible and safe.
• This method offers a viable solution for challenging single-port VATS left upper lobectomies.