Typical case presentation A 61-year-old male patient was admitted to the hospital with “right upper lung nodule found on physical examination for 1 year”. He had no other complaints of discomfort. A computed tomography (CT) scan showed a nodule with a rich blood supply in the right upper lung, approximately 2.5 cm in size, which was first considered as a peripheral type of lung cancer (Figure 1). Fiberoptic bronchoscopy was negative. Cranial magnetic resonance imaging (MRI), abdominal ultrasound and skeletal emission computed tomography (ECT) did not show any abnormality. Other routine examinations did not show any contraindications to surgery. Yang Yunhai, Department of Thoracic Surgery, Shanghai Chest Hospital Diagnosis and treatment The preoperative diagnosis was lung cancer. The operation was smooth and took 106 min, with intraoperative bleeding of about 100 ml. The chest drain was removed on postoperative day 3 and the patient was discharged on day 4, with no perioperative complications. Figure 1 Thoracic CT suggests a peripheral nodule in the right upper lung Figure 2 Bendable electronic thoracoscope Figure 3 Single-port VATS lobectomy procedure (A) through the incision, place ① double-jointed lung forceps for traction, ② electrocoagulation hook, ③ lens and ④ suction head, B) catheter-guided placement of a cutter closure to cut the right upper pulmonary vein, C) free the apical anterior branch artery and cut it with a cutter closure, D) cut the right upper lung bronchus, E (freeing the dorsal ascending branch artery, F severing the interlobular fissure, G placing a single chest drain at the end of the operation via the posterior margin of the incision) Postoperative pathology suggested peripheral adenocarcinoma of the upper lobe of the right lung. Case discussion The choice of surgical incision The choice of incision for single-port VATS lobectomy is mainly to facilitate the placement of a cutting closure device. If a lobectomy is performed with a cutting closure, the 4th intercostal incision in the anterior axillary line can facilitate the completion of the right lower and left lower lobectomies, but when the right upper, right middle and left upper lobectomies are performed, certain difficulties will be encountered, which can be solved by: ① abandoning the cutting closure and adopting Hem-o-lok clips, titanium clips or silk ligatures to deal with the pulmonary vessels, but their safety remains to be observed; ② adopting a bendable head end The present operation was performed with a bendable cutter-closure, which is convenient for the operation. The operation was performed using a catheter to guide the cutting closure through the right upper pulmonary vein, which made the operation smooth and less difficult. During the operation, the surgical instruments may interfere with each other and “fight” with each other. The solution is: ① The surgeons need to cooperate with each other for a long time to be familiar with the surgical ideas of both sides. ②Improve the surgical instruments and design special single-hole surgical instruments. Adequacy of drainage due to high placement of the drainage tube for single-port VATS lobectomy may result in inadequate postoperative drainage. The solution is: (1) to give the patient continuous negative pressure suction (-10 to -15) cmH2O after surgery. ② Encourage the patient to cough more after surgery and increase the activity appropriately to promote lung reopening and drainage of pleural fluid. In summary, combined with this case, we believe that compared with traditional VATS surgery, single-port VATS surgery can minimize trauma to the chest wall and reduce postoperative incisional pain and numbness symptoms. Single-port VATS right upper lung lobectomy + systemic lymph node dissection was performed using a bendable electronic thoraco-laparoscope with good surgical field of view, allowing observation of areas that are difficult to observe with conventional VATS. Single-port VATS surgery technically allows for individual lobe resection and even lung segment resection and pulmonary sleeve resection, but it needs to be done on the basis of previous experience in 3-port or double-port VATS operation. The development of this new technique is still in the exploratory stage, and further analysis of more cases and clinical evidence is still needed to study the clinical efficacy and benefits.