Uniportal hybrid robotic-assisted right upper sleeve lobectomy in an 83-year-old patient with severe pulmonary hypertension

We present a case of an elderly patient with necrotic lung cancer and severe pulmonary hypertension (PH) [pulmonary artery (PA) 68/24 mmHg, main pulmonary artery (mPA) 38 mmHg measured by right heart catheterization], who underwent a right upper sleeve lobectomy.We used a hybrid technique combining uniportal video-assisted thoracoscopic surgery (UVATS) with uniportal roboticassisted thoracoscopic surgery (URATS).The postoperative course of the patient was uneventful, being discharged on post-operative day (POD) 7. Pathology showed a squamous cell carcinoma pT3pN1cM0. Clinical vignetteAn 83-year-old patient with permanent atrial fibrillation, and severe PH was admitted to our department.Lung function was limited [forced expiratory volume in one second (FEV1) 1.41; 50%] and the patient had a large squamous cell carcinoma identified in the right upper lobe.Perfusion/ventilation scan showed 4.6%/3.8% in the right upper field.After evaluation by the tumor board, the patient was proposed for surgery.Due to the severe PH (68 mmHg systolic pressure), we performed a hybrid approach (UVATS-URATS) to reduce the surgical time.