Uniportal segmentectomy: an alternative for resection of deeply situated lung metastases

There is no high level of evidence that lung metastasectomy offers better outcome in terms of survival than non-operative treatment. Retrospective case series have identified some preoperative and postoperative risk factors for recurrence and survival that have impacted current practice. Indication for lung metastasectomy should be an individual decision, taken by multidisciplinary boards. However, once the decision for resection has been made, the surgeon has to figure out the best strategy to achieve complete resection with minimal harm to the patient. The least invasive procedure is therefore usually a combination of a minimally invasive access route with a lung-sparing resection technique. Multiport and especially uniportal video-assisted thoracoscopic surgery (VATS) are therefore ideal approaches from an access point of view. For metastases that cannot be removed by extra-anatomic resections, sublobar anatomic resections are an alternative to lobectomy. Combining the advantages of the uniportal access with the technique of the parenchyma sparing segmentectomy minimizes postoperative morbidity. We present this option, illustrated with 3 videos of cases undergoing uniportal segmentectomy for lung metastasis.