Tips and tricks of uniportal video-assisted thoracoscopic surgery complex segmentectomy

Uniportal video-assisted thoracoscopic surgery (U-VATS) has gained increasing recognition as a minimally invasive alternative to multiportal VATS (M-VATS), offering significant advantages such as reduced postoperative pain, shorter hospital stays, and fewer complications. While U-VATS has been successfully applied to complex segmentectomies, its technical demands necessitate advanced surgical skills, meticulous preoperative planning, and precise intraoperative management to ensure safe and effective outcomes. This article presents our institution's approach to performing complex segmentectomy using U-VATS, with a focus on key aspects such as preoperative imaging, anatomical considerations, intraoperative strategies, and technical refinements. By illustrating these techniques through a representative case of U-VATS right S1b + S3 segmentectomy, we provide practical insights into optimizing surgical outcomes and overcoming common technical challenges. Compared to previously published reports, this study offers a more detailed account of essential procedural nuances, including methods for securing adequate surgical margins, stabilizing the intersegmental plane, and efficiently handling the limited instrument maneuverability inherent to U-VATS. Additionally, we discuss the learning curve, technical prerequisites, and potential strategies for facilitating the broader adoption of U-VATS complex segmentectomy. We hope that this report serves as a valuable reference for thoracic surgeons seeking to refine their expertise in U-VATS and contributes to the ongoing evolution of minimally invasive thoracic surgery.