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The mini-invasive approach to superior sulcus tumors is an uncommon procedure that is still far from standardization. We describe a sequential surgical technique as robotic-assisted thoracoscopic surgery (RATS) lobectomy combined with first achieved exploratory surgery in our case, modifying the usual procedure, providing good access to both the apical and hilar sites in a less invasive manner, that allows safer dissection and better visualization, which dramatically contribute to the safety of this complex surgery. A 58-year-old man presented with right superior sulcus tumor, suspecting of invading the subclavian artery. After induction immunotherapy he underwent two stage surgical procedures, vascular open exploration, and control of the subclavian artery, which was none invaded by tumor and then robotic assisted thoracoscopic right upper lobectomy. The final pathology was ypT1aN0 adenocarcinoma. The technical aspects and indication for two stage or sequential surgery are discussed in this article, the advantages, and limitations of this procedure. We believe that by reducing the invasiveness of surgery itself, we could offer patients in some selected cases a more advanced approach. This sequential surgery, as delayed two-step procedures could optimize the treatment, secures operation, and diminishes intraoperative and postoperative complications.

journal of visualized surgery

Post-immunotherapy combined operative technique with an anterior surgical approach and robot-assisted lobectomy for an anterior superior sulcus tumor—case report