Left minimally-invasive upper lobectomy and chest wall resection using Gigli saw for non-small cell lung cancer: a case report

Background: Video-assisted thoracoscopic surgery (VATS) is the gold standard for anatomic lung resections. A VATS approach can be facilitated with thoracic manoeuvres using various instruments, such as the Gigli saw. However, chest wall resection with anatomic lung resection via a VATS approach using a Gigli saw is uncommonly reported.

Case Description: We present the case-report of an 81-year-old female with left upper lobe squamous cell carcinoma staged preoperatively as T2bN0M0 with possible chest wall invasion. The lesion was surgically resected via left VATS upper lobectomy en-bloc with removal of the 5th rib using a Gigli saw, left lower lobe wedge, and lymphadenectomy of stations 5 and 7, with final histopathological staging being pT3N0PL3R0. Postoperatively, the patient was discharged on day 8 with a portable chest drain due to ongoing air-leak. At 6-week follow-up, the patient was very well with no symptoms of chest pain, shortness of breath, or cough, with a well-healing wound. Their follow-up chest X-ray at 6 weeks was satisfactory with evidence of mild, likely reactive, left pleural effusion, but both lungs fully inflated.

Conclusions: In VATS, Gigli saw can be used in cancer cases necessitating chest wall resection following anatomical lung resection, with a favourable outcome.