How to Perform a Right Uniportal VATS Segment 7 Segmentectomy

This video demonstrates a uniportal video-assisted thoracic surgery (VATS) right segment 7 segmentectomy. This was a rare procedure that nicely delineated the anatomy and how it was visible from an anterior uniport VATS approach. 
 
The patient was a 67-year-old male with a background of rectosigmoid adenocarcinoma who had recently undergone liver resection (segment 6) for metastasis. Additionally, he had a 30-pack-per-year smoking history, which raised the possibility of a lung primary. Therefore, an anatomical lung parenchymal-sparing segment 7 segmentectomy was favored over a nonanatomical wedge resection. 

This video identifies and demonstrates the steps for reproducibly performing this procedure via an anterior uniport VATs approach. 

Steps 

The first step involved dissecting the mediastinal pleura and exposing the inferior pulmonary vein. Next, the medial basal segmental vein was exposed and divided. The B7 bronchus was then exposed and divided. Following this, the A7 artery was exposed and divided, and the station 12 lymph node was removed. The S7 segment was separated along the inflation and deflation line. Confirmation of the location of the tumor within the specimen was conducted. Finally, lymph node station 9 was harvested.  

Final pathology confirmed that the specimen contained a 13 mm deposit of colorectal adenocarcinoma, with a R0 resection achieved, as it was greater than 10 mm from the nearest staple line. 

References

1. Watanabe T, Tanahashi M, Suzuki E, Yoshii N, Kohama T, Iguchi K, Endo T. Uniportal Video-Assisted Thoracoscopic Segmentectomy for Early-Stage Non-Small Cell Lung Cancer: Overview, Indications, and Techniques. Cancers (Basel). 2024 Jun 26;16(13):2343. doi: 10.3390/cancers16132343. PMID: 39001405; PMCID: PMC11240445.

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