VATS Posterior Segmentectomy of the Right Upper Lobe

A 70-year-old patient was admitted to the authors’ department for a right upper lobe nodule resection. The patient had a personal history of prior smoking, and COPD (chronic bronchitis) requiring supplemental oxygen. He had no particular symptoms, but an x-ray revealed a nodule in the right upper lobe. A CT scan confirmed a 12 mm nodule, which had a malignant appearance on the PET scan. The nodule was not accessible for percutaneous transthoracic fine-needle aspiration. Bronchoscopy was normal. The FEV1 was 1.4L (55%) and the DLCO was 73%. Baseline pO2 was 50 mmHg and pCO2 45 mmHg. The peak VO2 during exercise was 11.8 ml/kg/min.

Considering the nodule size, location, and the increased risk if traditional lobectomy was performed, the authors planned a VATS posterior segmentectomy. A 3-4 cm utility incision was made anteriorly in the 5th intercostal space, and access for the thoracoscope was created in the 8th intercostal space in the posterior axillary line. A 12 mm nodule was detected in the right upper lobe. A single chest tube was inserted through the thoracoscope port at the end of the procedure, and was removed three days later. The patient was discharged on the fourth postoperative day. The final pathological result revealed a post-inflammatory scar without malignancy.