Uniportal video-assisted thoracoscopic surgery pneumonectomy: an update in the evolution of this minimally invasive approach

Despite the widespread adoption of uniportal video-assisted thoracoscopic surgery (UniVATS) for lung cancer, some procedures are still rarely performed with this approach. A minimally invasive approach is seldom selected to perform a pneumonectomy for a number of different reasons, usually involving the experience of the surgeon and the specific characteristics of cases requiring pneumonectomy as a treatment. Some surgeons believe that because of the complexity of such cases involving large tumors and usually some sort of hilum compromise, a minimally invasive technique cannot be safely performed. Safety involved in performing this procedure is more related to the surgeon experience in the approach than to the procedure itself, and it mostly depends on prior exposure to complex uniportal cases. In a time when several groups around the world are performing bronchovascular reconstructions, carinal resections by UniVATS the question should not be if is possible to perform UniVATS pneumonectomy, but what are the factors and considerations the surgeon must take into account in order to perform these cases. This review aims to provide an update on current status of uniportal VATS pneumonectomy and to provide guidance for surgeons who face this sort of cases.