Video-assisted thoracoscopic surgery lingular segmentectomy with pericardial resection and reconstruction

We describe a patient with a metastatic lung mass who underwent video-assisted thoracoscopic surgery (VATS) lingular segmentectomy with pericardial resection and reconstruction as minimally invasive surgery. There was a metastatic mass arising from cervical cancer in the lingular segment. Because the mass was obviously larger than the intercostal space, we made a subxiphoid incision besides usual ports for VATS segmentectomy to remove a specimen. Intraoperatively, we found pericardial invasion by the mass. The pericardium was safely resected with the use of a bipolar vessel sealing system. To reconstruct the pericardium under thoracoscopy, we devised two techniques. One was the use of a thread to measure the defect size. A stretched thread was placed on the defect to determine its length. By referring to the defect length, we could cut a covering material of proper size. The other technique was that the needle tip should not be pointed towards the heart to ensure that the pericardium can be sutured safely. These techniques allowed us to reconstruct the pericardium relatively easily and safely.