Uniportal video-assisted thoracoscopic surgery (U-VATS) bronchial and vascular sleeve resections: technical aspects and review

: Since uniportal video-assisted thoracoscopic surgery (U-VATS) was described in the early 2000s, both acceptance and implementation of the technique have spread worldwide. Many thoracic surgeons have adopted this approach as the standard in their clinical practice and as experience has been acquired, indications have been extended to more complex surgical procedures such as bronchial and even bronchovascular sleeve resections for centrally located tumours with hiliar involvement. Accordingly, benefits of parenchymal lung-sparing surgery are combined with those derived from the minimally invasive approach, achieving the highest quality in this kind of interventions. The aim of this article is to facilitate the implementation of the technique by presenting an updated review supported by our experience that contributes to standardise indications and technical aspects. We also reviewed the results of U-VATS bronchovascular sleeve resections compared to pneumonectomy and the classic thoracotomy approach concluding that these techniques are safe, reproducible and standardizable. Despite promising results, there is not enough evidence in terms of perioperative outcomes and long-term survival in NSCLC for the official clinical guidelines to incorporate U-VATS sleeve bronchoplastic resections into their clinical practice recommendations. Due to the level of difficulty, it is important to emphasize the importance of a multidisciplinary surgical team with extensive previous experience in both U-VATS and broncho-angioplastic procedures.