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Video-assisted thoracoscopic surgery (VATS) lung-sparing anatomical resections preserve healthy pulmonary parenchyma but also lead to good resection margins. Oncological outcomes are similar when compared with lobectomy for the treatment of early stage lung adenocarcinoma. VATS technique to perform classical anatomical segmentectomies is well defined and even in highly experienced teams, these procedures can be performed by uniportal VATS. However, the achievement of unusual central anatomical segmentectomies through Uniportal VATS remains a challenge. We describe a feasible and reproducible technique to perform uniportal VATS right lower lateral and posterior (S9–10) anatomical segmentectomy for the treatment of early stage lung cancer.

In recent years, the video-assisted thoracic surgery (VATS), and uniportal VATS approach has become the routine approach in numerous centers. Nevertheless, uniportal VATS learning curve is a challenge even for those surgeons with experience in multiportal VATS surgery. Among the surgeons who prefer the use of the multiportal VATS approach it is noteworthy that many of them are more comfortable through several ports because they feel this approach is more ergonomic. We present our routine programme of VATS surgery assisted by articulated arm (AVATS) for major resections, as a technique that allows ergonomic surgery for both, surgeon and first assistant and cooperative surgical field when is needed.