Uniportal VATS LUL(tumor involved with phrenic nerve) Authors: Yinliang Sheng M.D, Yu Qi Ph.D, Chunyang Zhang Ph.D, Ping Yuan Ph.D,Bin Wu M.D The First Affiliated Hospital of Zhengzhou university Corresponding Author:Yinliang Sheng,1024223908@qq.com,15093145318 Abstract:A 53 years old man came to us with a thick-walled cavity located on the left upper lobe that was revealed on a CT scan of chest. Enlarged lymph nodes were identified around mediastinum and pulmonary hilus. CT-guided biopsy yield a histopathologic analysis positive for sarcomatoid carcinoma, surgical resection was arranged after excluding distant metastasis. Uniportal video-assist lobectomy was performed through a small incision along the mid-axillary line at the 5th intercostal. Routine surgical exploration found the lesion had invaded to the mediastinal pleura where the phrenic nerve passes by, clearly the nerve had been encapsulated into the tumor. Fortunately, the mobility and flexibility of tumor and its surrounding tissue suggested the invasion has not been reached to pericardial vascular and tissue, so we suppose the tumor is operable to be removed. Because the CT scan showed a suspicious lymph node permeation in the main pulmonary artery and upper lobe bronchus, so we decide the block the vein of left upper lobe and search the lymph node. After we have dissected the left upper pulmonary vein, so the forceps is easy to get through. If dissecting interlobar lymph node and artery is difficult, preventive blocking of pulmonary aorta would be necessary. We finally complete the resection of left upper lobectomy and systematic lymphadenectomy. Conflict of interests: None.

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