Video-assisted limited anterior thoracotomy approach for lingular segmentectomy and left anterior descending coronary artery bypass.

Minimally invasive cardiothoracic combined surgery was performed successfully in an octogenerian with left anterior descending coronary artery disease and concurrent adenocarcinoma in the lingular segment of emphysematous lung. Through a limited anterior 4th intercostal thoracotomy, left anterior descending coronary artery bypass grafting without cardiopulmonary bypass was carried out using the left internal thoracic artery (LITA) and the interposed vein graft, and subsequently lingular segmentectomy was accomplished. Videothoracoscopy via a single port placed at the 5th intercostal space below the left nipple was useful for LITA mobilization, lymph nodes sampling and endo-cutter guidance.