An elderly male patient was found to be with "nodule in upper lobe of right lung" during his health examination, although without any symptom. Chest CT at admission showed that the nodules were close to the superior vena cava, and CT reconstruction displayed an adipose space between the nodules and the superior vena cava. However, bronchoscopy showed negative results. Pre-operative exploration showed that the right upper lung nodules were tightly attached to the surface of superior vena cava and could not be effectively divided; an invasion could not be ruled out. The surgery was performed in a distal-proximal manner. The pulmonary fissure, bronchi, and arteries were divided firstly, followed by veins and the surrounding tissues of the lung. After the surrounding spaces of the tumor were sufficiently disassociated, superior vena cava angioplasty was performed using a stapler. The surgery was performed completely under thoracoscopy, during which the surgical incision was not enlarged. The main operation port was about 4 cm in diameter. Two axillary operation ports (about 1.2 and 0.6 cm in diameter, respectively) were also used. All the surgical equipment were used smoothly, and thus the surgery was completed with lowest invasion.
Keywords: Lung cancer; VATS; angioplasty; superior vena.