# Right upper lobectomy with mediastinal dissection under uniportal video-assisted thoracoscopic surgery for lung cancer in a patient with a right-sided aortic arch: a case report

## TL;DR

A patient with a rare aortic arch variation successfully underwent a minimally invasive lung cancer surgery using a specialized technique.

## Contribution

This is the first reported case of uniportal VATS lobectomy with mediastinal dissection in a patient with a right-sided aortic arch.

## Key findings

- Uniportal VATS lobectomy is feasible in patients with a right-sided aortic arch.
- The right recurrent laryngeal nerve was found to branch from the right vagus nerve and hook around the aortic arch.
- A technique for stapler manipulation over the azygos vein was used to overcome surgical challenges.

## Abstract

A right-sided aortic arch is a rare congenital vascular structure variation. Right lobectomy is not commonly performed on patients with such a condition. Further, there are no reports on lobectomy under uniportal video-assisted thoracoscopic surgery (VATS) in this patient group.

A 67-year-old man with a right-sided aortic arch and Kommerell diverticulum underwent right upper lobectomy with mediastinal lymph node dissection under uniportal VATS for primary lung cancer. Due to the right descending aorta, which narrows the space of the dorsal hilum, handling of the stapler for stapling the right upper lobe bronchus from the uniport in the 6th intercostal space at the medial axillary line can be challenging. This issue was resolved by manipulating the staple over the azygos vein toward the inferior margin of the aortic arch. Via mediastinal lymphadenectomy, we found that the right recurrent laryngeal nerve branched from the right vagus nerve and hooked around the right-sided aortic arch.

Right lobectomy with mediastinal lymph node dissection under uniportal VATS can be performed for lung cancer in patients with a right-sided aortic arch.