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Highly Complex Minimally Invasive Lung Tumour Surgery Performed at Riga East Clinical University Hospital
Thoracic surgeons from the Clinic of Thoracic Surgery and Interventional Pulmonology of Riga East Clinical University Hospital have successfully performed a highly complex minimally invasive procedure—a uniportal video-assisted thoracoscopic surgery (VATS) double sleeve lobectomy—on a 67-year-old male patient diagnosed with lung cancer.
The patient was diagnosed with central squamous-cell carcinoma of the left lung, with tumour involvement extending from the upper lobe into both the left main bronchus and the pulmonary artery. Despite the complexity of the condition and the traditionally high risk of pneumonectomy in such cases, the surgical team was able to preserve the lung using an advanced reconstructive approach. The postoperative course was uneventful, and due to the minimally invasive technique, the patient was discharged on the eighth postoperative day.
Innovation is a continuous driving force in medicine and surgery, and thoracic surgery is no exception. Ten years ago, East Hospital performed its first uniportal VATS lobectomy—a procedure carried out through a single surgical incision. Prior to the introduction of this approach, VATS lobectomies were typically performed through two or three incisions, similar to conventional laparoscopic surgery.
At the end of 2025, surgeons from the Clinic of Thoracic Surgery and Interventional Pulmonology (Centre of Tuberculosis and Lung Diseases) of East Hospital achieved a further milestone by performing a highly complex minimally invasive reconstructive procedure—a combined bronchial and vascular sleeve (double sleeve) lobectomy—using the uniportal VATS technique.
The surgery was conducted in two stages. First, the tumour was removed together with the affected portions of the bronchus and pulmonary artery. In the second stage, both the bronchial and arterial structures were reconstructed using precise end-to-end anastomoses. Due to the technical complexity and inherent risks, such procedures are traditionally performed via open lateral thoracotomy. In this case, however, the operation was successfully completed through a single 3.5 cm incision, significantly reducing surgical trauma and postoperative risk.
“Due to anatomical and physiological factors, thoracic surgery is often associated with more pronounced postoperative pain compared to operations in other regions of the body. This is why minimally invasive techniques are particularly important in thoracic surgery,” explains thoracic surgeon Rihards Mikilps-Mikgelbs from the Clinic of Thoracic Surgery and Interventional Pulmonology.
Postoperative recovery was excellent, and the patient continues to recuperate at home. Histopathological examination confirmed the radicality of the resection. Following multidisciplinary discussion, no additional oncological treatment was deemed necessary.
About Uniportal VATS Lobectomy
Uniportal VATS lobectomy is an advanced minimally invasive thoracic surgical technique in which a lung lobe is removed using video-assisted thoracoscopy.
- The procedure is performed through a single small incision between the ribs (uniportal approach), typically 3–4 cm in length.
- A high-definition video camera and specially designed narrow instruments allow for precise surgical manipulation.
- Preservation of intercostal nerves significantly reduces postoperative pain and supports faster recovery.
- International studies have demonstrated that VATS lobectomy is oncologically safe and effective, while providing patients with a superior postoperative quality of life compared to traditional open surgery.
Surgical Team
The procedure was performed by the multidisciplinary team of the Tuberculosis and Lung Disease Centre of East Hospital:
- Thoracic surgeons: Rihards Mikilps-Mikgelbs, Marina Gaidukova, Ints Siliņš
- Thoracic surgery resident: Filips Aksjutins
- Anaesthesiologists: Marina Lubgāne, Ineta Blumberga
- Operating room nurses: Sanita Riekstiņa, Anda Vanaga
- Anaesthesia nurse: Ilga Priekule
- Nurse assistant: Jeļena Rjabinkova
Since 2017, thoracic surgeons at East Hospital have been performing complex bronchoplastic and sleeve resections using the uniportal VATS technique. This experience has received recognition at the international level.
About Riga East Clinical University Hospital
Riga East Clinical University Hospital is the largest and most strategically significant multi-profile hospital in Latvia. The hospital comprises five inpatient facilities—Gaiļezers, Latvian Oncology Centre, Biķernieki Hospital, Tuberculosis and Lung Disease Centre, and the Latvian Infectious Diseases Centre—as well as numerous specialised centres and clinics.
The hospital provides highly specialised inpatient and secondary outpatient healthcare, offering multidisciplinary tertiary-level treatment in accordance with the latest medical knowledge and technologies. Approximately 80% of all cancer patients in Latvia receive treatment at East Hospital. The institution also serves as a clinical training base for Latvian and international medical students and healthcare professionals, actively contributing to education, research, and the development of innovative treatment methods. With approximately 5,000 employees, it is the third-largest employer in the country.
