非气管插管孔VATS复杂左上肺（手术）

                               
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This video shows that even challenging cases with strong adhesions or complex hilum can be performed safely under spontaneous ventilation in expert hands. The management of the anesthesiologist is crucial for a successful operation.
The case was a live surgery performed from National Taiwan University Hospital during the 4th Single port Asian meeting held in Taipei, on 9-10th April 2016. The surgery was broadcasted to an auditorium during the congress. The patient presented a small tumor located on the lingula, and the procedure was performed under spontaneous ventilation, with no intubation. No epidural was employed, only local anesthesia and vagus blockade.
The lung was totally attached to the parietal pleura with severe strong adhesions to the diaphragm. The lingular artery was blocked by calcified lymph nodes and the dissection was challenging.
The anatomic segmental resection was performed by using a thoracoscopic single 3 cm incision. After the resection a lymph node dissection was carried out. The recovery of the patient was uneventful after surgery
Dr Gonzalez Rivas, MD, FECTS
Video edited by Dr Shun-Mao Yang from NTUH