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Thoracic surgery started the path to minimally invasive surgery over a hundred years ago, with the first thoracoscopic procedure performed by Jacobeus in 1910. Interestingly, these first procedures were performed using a single port approach and were used for diagnostic and minor procedures only. For a long period of time, the progress for minimally invasive thoracic surgery was considerably slow until the early 90s, when video assisted thoracic surgery started to be used for major pulmonary resections. Since then, video-assisted thoracic surgery (VATS) had a widespread use around the world and an ongoing search for a less invasive procedures evolved into uniportal VATS. Now, thoracic surgeons have a variety of choices for minimally invasive thoracic surgery and must be trained in these approaches to keep up with the evolution of the specialty and be up to date with the recommended treatments for diseases needing surgical intervention. The approach chosen by each surgeon is a matter of preference, while keeping in mind certain characteristics specific to the pathology and patient to be treated, the level of training of the surgeon, and the healthcare resources available. As more evidence is collected, the choice for video-assisted procedures, which have currently been proven safe, effective, less invasive and, in general, show good results, will prevail., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

The uniportal approach for major pulmonary resections began in 2010 with the first case being performed by González-Rivas and colleagues in La Coruña. Since then a number of teams around the world had being performing hundreds of cases, applying it to more advance and complex cases recently. The technique has been reported to be feasible and reliable with similar results to that obtained in early stage lung cancer lobectomies. The case presented in this article is an example of an extreme condition: very obese patient, strong adhesions, fused lower lobe to the diaphragm and enlarged inflammatory adenopathies that made the procedure very technically challenging. In addition, the surgery was performed during a live surgery event and it was broadcasted to an auditorium. However, the case was successfully completed through a uniportal VATS approach with no complications.