Lung cancer is one of the leading causes of cancer-related mortality worldwide. While surgery remains the cornerstone treatment for early-stage non-small cell lung cancer (NSCLC), traditional thoracotomy is associated with significant morbidity. Multiportal Video-Assisted Thoracoscopic Surgery (VATS) improved recovery outcomes, but uniportal VATS — first described in 2011 — represents an even less invasive refinement, using just a single small incision.
Although widely adopted in metropolitan centres, uniportal VATS is rarely performed in tier-3 cities. At Porunai Hospitals, Tirunelveli, we are proud to present the first two cases of uniportal VATS lobectomy for lung cancer in South Tamil Nadu, showcasing the safety and success of this approach for patients.
Case 1:
Uniportal VATS Left Lower Lobectomy in a 56-Year-Old Male
- Presentation: Non-smoker with chronic cough for 1 month.
- Investigations:
- CT thorax: suspicious mass in the left lower lobe.
- PET-CT: 4.2 × 3.8 × 3 cm metabolically active lesion, no metastasis.
- Endobronchial Ultrasound (EBUS) with cone biopsy (first of its kind in South Tamil Nadu at Porunai): confirmed adenocarcinoma.
- Treatment: After preoperative evaluation (PFT, DLCO, cardiology clearance), the patient underwent uniportal VATS left lower lobectomy via a 3 cm incision.
- Recovery: Extubated on-table, uneventful postoperative course, discharged on POD 4.
- Pathology: pT2N2 adenocarcinoma.
- Next Step: Initiated on adjuvant chemotherapy.
Case 2:
Uniportal VATS Right Lower Lobectomy in a 55-Year-Old Female
- Presentation: Non-smoker with pleuritic chest pain for 2 weeks.
- Investigations:
- CT thorax: peripheral lesion in the right lower lobe.
- PET-CT: 3 × 3 cm metabolically active lesion, no metastasis.
- EBUS with cone biopsy: confirmed adenocarcinoma.
- Treatment: Preoperative PFT showed restrictive lung disease. Optimised over 2 weeks, then underwent uniportal VATS right lower lobectomy.
- Recovery: Extubated on-table, developed postoperative lower respiratory tract infection, managed with antibiotics. Discharged on POD 8.
- Pathology: pT2N2 adenocarcinoma.
- Next Step: Started on adjuvant chemotherapy as per multidisciplinary tumour board guidance.
Expanding Access to Minimally Invasive Lung Cancer Surgery
Uniportal VATS has rapidly gained global recognition as a safe and effective alternative to multiportal VATS and open thoracotomy for anatomical lung resections. Technological advances in camera systems and stapling devices have made it possible to perform complex resections through a single incision while minimising surgical trauma and enhancing visualisation.
This case series demonstrates that Porunai Hospitals has successfully introduced uniportal VATS to South Tamil Nadu. Both patients received anatomical lobectomy with oncological clearance and uneventful recovery, highlighting the viability of providing such advanced care in a tier-3 city.
Due to the minimally invasive approach of uniportal VATS, both patients recovered more quickly than with traditional methods. Chemotherapy, the next phase of treatment, could be started as early as 3 weeks post-surgery, giving a timely window of opportunity for full cancer treatment. By decentralising intricate thoracic oncology treatment, Porunai ensures that patients in the area do not have to travel long distances to distant metropolitan hospitals for high-end cancer surgery.
Expert Surgical Team and State-of-the-Art Facilities
The surgeries were performed by Dr. Harish Kumar L., Consultant Surgical Oncologist, who served as the lead surgeon. He was supported by a highly skilled multidisciplinary team that included Dr. Prabakaran, Consultant Thoracic Oncologist (Visiting, trained at the Shanghai Pulmonary Centre), and Dr. Thiyagesh Ganapathy, Interventional Pulmonologist, who carried out the region’s first EBUS with cone biopsy. The anaesthesia team was supported by Dr. Yogesh Kumar R, Onco-Anaesthetist, along with Dr. Sathish Krishnan, Anaesthetist, with Dr. Guneshwaran from the Critical Care and ICU team providing continuous perioperative and postoperative support.
Porunai Hospitals is committed to breaking barriers in cancer treatment by making the latest surgical methods more accessible to the community. Apart from uniportal VATS, the hospital also performs a host of complex procedures on a routine basis, such as laparoscopic hemicolectomy and colorectal surgeries, laparoscopic sentinel node biopsy, laparoscopic esophagectomy, breast oncoplasty with sentinel node biopsy, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).
Setting a New Benchmark in Cancer Care
This series of cases is the first documentation of uniportal VATS lobectomy in lung cancer in South Tamil Nadu, demonstrating the safety and efficacy of such advanced thoracic surgeries at a hospital in Tirunelveli. With a proficient team of specialists and the latest infrastructure, Porunai Hospitals aims to make the best of cancer care accessible within the reach of patients.