With the increasing awareness of investigation and the continuous improvement in the level of diagnostic techniques, more and more cases of stage I lung cancer are being detected clinically, and the increase in the number of adenocarcinoma cases and the decrease in the number of squamous carcinoma cases has become a development trend of lung cancer, and the incidence of lung adenocarcinoma has accounted for 70% of non-small cell lung cancer in Japan. Lobectomy with mediastinal lymph node dissection is currently recognized as the standard mode of surgical treatment for early and mid-stage non-small cell lung cancer, but for elderly lung cancer patients, the selection of their indications for open-heart surgery and perioperative management are complicated by their declining physiological function and chronic disease invasion, and some patients lose the best time for surgery that they deserve. Television thoracoscopic limited pneumonectomy includes television thoracoscopic lung wedge resection and lung segmental resection. Compared with open-heart surgery, TV thoracoscopic surgery has shown significant superiority in both operative time, intraoperative bleeding, and postoperative air leakage, chest drainage and postoperative pain, and hospitalization days. Thoracoscopic surgery can significantly reduce shoulder mobility disorders, and postoperative lung function indexes, short- and long-term quality of life are better. Although there is an increased possibility of local recurrence with limited pneumonectomy, this procedure allows more preservation of normal lung tissue, which is conducive to the preservation and recovery of postoperative lung function; on the other hand, performing wedge resection or segmental resection of the lung also reduces the volume of the lung on that side, which plays a role in lung volume reduction to a certain extent. Therefore, compared with lobectomy, limited pneumonectomy is associated with lower perioperative complications and mortality. The literature reports that in patients who are too old to tolerate lobectomy, limited pneumonectomy can achieve a 5-year survival rate similar to that of conventional lobectomy. Therefore, TV thoracoscopic limited pneumonectomy may be the most ideal treatment for elderly patients with early-stage lung cancer. Strictly grasping the indications for surgery is the key to obtaining surgical radical cure. Preoperative chest CT showing no signs of pleural thickening, tumor located in the peripheral part, and no enlarged hilar and mediastinal lymph nodes are the basic requirements for surgery. The maximum diameter of the tumor is 1-3 cm, and tumors larger than 3 cm are not easy to ensure that the possible local metastases can be cut. Blood gas analysis should be performed for those with low lung function.
PaO2 and PaCO2 should be within the normal range. PaO2>200mmHg after 10 minutes of pure oxygen can be considered for surgery. The preoperative preparation should be adequate, and for comorbidities preoperative treatment should be given for about 2 weeks accordingly, and with respiratory physiotherapy to create the necessary conditions for surgery. Perfect surgical procedure is the key to ensure the safety of surgery and reduce postoperative complications. First of all, anesthesia is smoothly induced, and clinical doses of isoproterenol have no significant inhibitory effect on HPV, which is a more ideal drug for one-lung ventilation anesthesia. PCV mode should be used for one-lung ventilation, which can effectively prevent pulmonary atelectasis and pneumonia, avoid V/Q dysregulation as much as possible, and reduce the limiting peak airway pressure. Due to the small size of the tumor, intraoperative finger palpation is often required. The choice of the second operative incision is also crucial, and it can effectively shorten the operative time. The lung wedge should be resected with a wide margin and as far as possible along the morphology of the lung to prevent possible residual local metastases and to provide lung decongestion as much as possible. The lung section should be covered with hemostatic gauze or fibrin glue sprayed on the wound surface to prevent pulmonary hemorrhage and air leakage when the lung section is large.