Background: Video-assisted thoracoscopic surgery (VATS) using a single incision (uniportal) may result in better pain control, earlier mobilization and shorter hospital stays. Here, we review the safety and efficiency of our initial experience with uniportal VATS and evaluate our learning curve. Methods:We conducted a retrospective review of uniportal VATS using a prospectively maintained departmental database and analyzed patients who had undergone a lung anatomic resection separately from patients who underwent other resections. To assess the learning curve, we compared the first 10 months of the study period with the second 10 months. Conclusions: Uniportal VATS was safe and feasible for both standard and complex pulmonary resections.However, when used for pulmonary anatomic resections, uniportal VATS entails a steep learning curve.

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Pulmonary carcinoid tumours are well-differentiated neuroendocrine tumours with indolent behaviour; complete resection offers long-term survival. When centrally located, these tumours can be treated with lung-sparing procedures. We present a case of a centrally located typical carcinoid tumour treated with a minimally invasive, right upper lobe sleeve lobectomy using a single port.

OBJECTIVES This study reports the results of an international expert consensus process evaluating the assessment of intraoperative air leaks (IAL) and treatment of postoperative prolonged air leaks (PAL) utilizing a Delphi process, with the aim of helping standardization and improving practice. METHODS A panel of 45 questions was developed and submitted to an international working group of experts in minimally invasive lung cancer surgery. Modified Delphi methodology was used to review responses, including 3 rounds of voting. The consensus was defined a priori as >50% agreement among the experts. Clinical practice standards were graded as recommended or highly recommended if 50–74% or >75% of the experts reached an agreement, respectively. RESULTS A total of 32 experts from 18 countries completed the questionnaires in all 3 rounds. Respondents agreed that PAL are defined as >5 days and that current risk models are rarely used. The consensus was reached in 33/45 issues (73.3%). IAL were classified as mild (<100 ml/min; 81%), moderate (100–400 ml/min; 71%) and severe (>400 ml/min; 74%). If mild IAL are detected, 68% do not treat; if moderate, consensus was not; if severe, 90% favoured treatment. CONCLUSIONS This expert consensus working group reached an agreement on the majority of issues regarding the detection and management of IAL and PAL. In the absence of prospective, randomized evidence supporting most of these clinical decisions, this document may serve as a guideline to reduce practice variation.

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IntroductionThe ongoing evolution of radiologic imaging techniques has allowed a precise correlation between lung histology a n d c o m p u t e r t o m o g r a p h y i m a g i n g . R a d i o l o g i c descriptions of ground glass opacity (GGO) with or without solid components directly correlate (1) with the latest adenocarcinoma classification (2) and so far, with oncologic prognosis. The clinical assessment of these opacities, the location, the number of lesions and the ratio of solid component define the proper surgical approach. We are frequently challenged with patients with not only a single GGO, but also multiple GGOs requiring a case-by-case strategy. This is the case report of a patient with multiple GGOs. Case presentationAn asymptomatic 72-year-old female, previous smoker (quit 30 years ago), without significant comorbidities, presented with multiple GGOs with three dominant lesions. The major lesion was in the superior segment of the right lower lobe (RLL). It measured 3.4 cm, with mixed GGO and a 1.5 cm solid component, with a standardized uptake value (SUV) of 3.3 on positron emission tomography (PET). The second lesion was in the posterior segment of the right upper lobe (RUL), measured about 1cm and was inactive on PET. The third lesion was in the posterior segment of the left upper lobe, also measured 1cm and was inactive on PET. There were other multiple infracentimetric GGOs in both lungs, without mediastinal lymph node involvement or distant metastasis at computed tomography (CT)-scan or PET scan. A transthoracic needle biopsy of the RLL lesion confirmed an adenocarcinoma. A full clinical pre-operative evaluation was performed and the patient was considered fit for surgery. SurgeryUnder general anesthesia and one-lung ventilation, the patient was installed in a left lateral decubitus, with the hips flexed. Surgery was performed through single port technique, with a 4-cm incision in the 5 th right intercostal space, between the anterior axillary and midaxillary lines. After confirming resectability, both lesions of the right lung were identified. Due to the absence of posterior fissure between the RUL and the RLL, both tumors had to be resected en bloc to preserve oncologic principles. So, from the main artery we planned to resect towards the posterior segment of the RUL and towards the superior segment of the RLL. Abstract: Modern thoracic surgery requires the ability to manage patients with ground glass opacities (GGO). However, due to the lack of a standardize approach in our institution these cases are discussed in the tumor board. We here present our therapeutic rationale in a case of a patient with multiple GGOs, who underwent an en-bloc anatomic bisegmentectomy as surgical treatment for a synchronous lung adenocarcinoma.