title: Total video-assisted thoracoscopic (VATS) resection of a left-sided sulcus superior tumor after induction radiochemotherapy: video and review.
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) has gained increasing acceptance for surgical therapy of early stage non small cell lung cancer (NSCLC). Even for extended pulmonary resections in advanced tumor stages, increasing evidence suggests feasibility and safety of the VATS approach. However, so far very little experience has been reported on VATS management of sulcus superior tumors.
  
  
  METHODS
  We report on a 56-year-old female patient with a left-sided anterior sulcus superior adenocarcinoma (cT3 cN1 cM0), which was completely resected by VATS after induction radiochemotherapy.
  
  
  RESULTS
  The surgical procedure was performed completely minimally invasively via a three-incision anterior thoracoscopic approach. The total operating time was 285 min (composed of 116 min for hilar lobectomy, 103 min for sulcus superior preparation and chest wall resection, and 26 min for systematic en-bloc lymph node dissection). The single chest tube was removed on postoperative day two and the patient was discharged on postoperative day six. No intraoperative and no postoperative complications were observed. Histopathology confirmed a complete (R0) resection of an ypT2aN0M0 bronchogenic adenocarcinoma.
  
  
  CONCLUSIONS
  With increasing experience even extended pulmonary resections are safe and feasible by a video-assisted thoracoscopic approach. We propose that in sulcus superior tumors without tumor invasion of vascular structures VATS can be considered.
authors.affiliation: Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Street 7, 35392, Giessen, Germany, martin.reichert@chiru.med.uni-giessen.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Reichert
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kerber
authors.forename: Anca-Laura
authors.initials: AL
authors.lastname: Amati
authors.forename: Johannes
authors.initials: J
authors.lastname: Bodner
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008875:Middle Aged; D061646:Operative Time; D020775:Thoracic Surgery, Video-Assisted; D013906:Thoracoscopy