Left sleeve pneumonectomy via uniportal video-assisted thoracoscopic approach

Left sleeve pneumonectomy is a rarer intervention compared with right sleeve pneumonectomy. It is a challenging surgical therapeutic strategy even when performed through open thoracotomy. Here, we report a case of uniportal video-assisted thoracoscopic surgery (VATS) left sleeve pneumonectomy in a patient with non-small cell lung cancer. The tumor, located at the opening of left upper lobe bronchus, submucosally invaded the orifice of lower lobe extending upward to 4 to 5 cartilage rings of the left main bronchus and to the level of the carina. Left sleeve pneumonectomy and airway reconstruction was performed through video-assisted thoracoscopic completely with an incision of 4 cm. The total operative time was 220 minutes and the estimated intraoperative blood loss was 300 mL. Chylothorax occurred after surgery, which was well handled, and no other severe complication was observed. Three months after the surgery, the follow-up bronchoscopy revealed good healing of the anastomosis. No signal of tumor recurrence was observed by follow-up examination 1 year after the surgery. To our knowledge, this is the first reported uniportal VATS left sleeve pneumonectomy in the world. It was indicated that uniportal VATS might be a feasible approach for left sleeve pneumonectomy, with less surgical trauma compared with other approaches.