The techniques of uniportal video-assisted thoracoscopic surgery: lower lobectomies and lymphadenectomy

Uniportal video-assisted thoracoscopic surgery (VATS) is probably the most successful single-incision approach worldwide, probably secondary to several specific circumstances: multiportal VATS was hardly getting his recognition in the thoracic surgeon's community; the extraordinary effort by his creators and believers for developing the technique and giving massive diffusion; the subjective feeling by surgeons who performed the approach about its benefits and advantages. Despite this, many efforts have focused on extending new indications and describing variations of the original intercostal uniportal VATS, but few quality papers have analyzed the real impact of the approach and its real advantages or disadvantages comparing to multiportal VATS. Thus, many surgeons still feel little confidence on the approach and reject his performance. With the aim of standardizing the approach and the technical aspects for non-experienced or beginners, the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgery (ESTS) decided to set the basis for homogenization of the technique to cement the development of high-level evidence works that shed light on the real outcomes of uniportal compared to multiportal VATS. This article describes the main specific technical aspects while performing lower lobectomies and lymphadenectomy, which were described as the most suitable cases for initiating the learning curve.