VATS Intrapericardial Left Pneumonectomy for Centrally Located Lung Tumor: Step-by-Step Approach With Technical Pearls

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This clinical video presents a step-by-step demonstration of a video-assisted thoracoscopic surgery (VATS) intrapericardial left pneumonectomy performed for a centrally located non-small cell lung carcinoma (NSCLC). The patient presented with a tumor involving the left main bronchus closely abutting the inferior pulmonary vein without mediastinal invasion or distant metastasis. 
 
After standard preoperative evaluation, the procedure was performed under general anesthesia with double-lumen endotracheal intubation. A triportal VATS approach was utilized. Following lung mobilization, the pericardium was opened anterior to the phrenic nerve. Intrapericardial dissection was meticulously carried out to control the pulmonary vessels. The left pulmonary artery was divided using an endoscopic vascular stapler. Due to the close proximity of the tumor to the inferior pulmonary vein, the vein was carefully divided and sutured manually to ensure safe and controlled resection. Subsequently, the left main bronchus was dissected and divided, and the bronchial stump was checked for air leaks under saline immersion. A systematic mediastinal lymph node dissection was also performed. 
 
Pathological examination revealed a 6 x 5 cm tumor with negative surgical margins. No intraoperative or early postoperative complications occurred. The patient had an uneventful recovery and was discharged on postoperative day five. 
 
This video aims to demonstrate the feasibility of the VATS approach in selected complex cases requiring intrapericardial dissection and highlights key technical tips for safe vascular and bronchial management. 

References

1. Ceylan, K.C., Batıhan, G. & Kaya, Ş.Ö. Three Ports One Lung: Videothoracoscopic Pneumonectomy for Lung Cancer. Indian J Surg 85 (Suppl 2), 452–458 (2023). https://doi.org/10.1007/s12262-022-03567-1
2. Batıhan, G., Ceylan, K.C. A case series of VATS intrapericardial pneumonectomy: a bi-centric experience. J Cardiothorac Surg 19, 696 (2024). https://doi.org/10.1186/s13019-024-03270-0

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