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Anatomic Uniportal VATS Combined Subsegmentectomy of Right Lung S4a, S5ai, S6b, S8a and S9a
Jian Fang.
Yantai Yuhuangding Hospital, Yan tai, China.
BACKGROUND:To report a case of single-port thoracoscopic RS4a+5ai+6b+8a+9a resection for bilateral right lung ground-glass nodules (GGNs) and discuss key strategies for ensuring surgical margin and preserving lung function.
METHODS:A 49-year-old male with two GGNs (right middle and lower lobes) unresponsive to anti-inflammatory treatment (highly suspected early lung cancer, middle 1/3 lung field location) underwent single-port thoracoscopic RS4a+5ai+6b+8a+9a resection after preoperative HRCT and 3D reconstruction. Intraoperative difficulties and solutions were summarized.
RESULTS:The operation was successful (operative time: about 210 min, blood loss: about 100 mL). Key intraoperative measures included accurate transection of subsegmental/subsubsegmental veins within the safety margin, Hem-o-lock marking for margin protection near S10, and adjusted strategy for unrecognized V5ai (interlobar type, draining into V3) by prioritizing horizontal fissure dissection. Postoperative pathology confirmed adenocarcinoma in situ (right middle lobe) and minimally invasive adenocarcinoma (right lower lobe) with negative margins. The patient recovered uneventfully (chest tube removal on POD 3, discharge on POD 4), with favorable lung function and no recurrence at 1-month follow-up.
CONCLUSIONS:Single-port thoracoscopic combined subsegmental resection with flexible intraoperative strategy adjustment is safe and effective for multiple middle-field GGNs, ensuring radical resection while preserving lung function.
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