Our technique of combined full thoracoscopic (no access incision) and posterior midline approach for en bloc resection of non-small cell lung cancer invading the spine: tips and tricks.

En bloc resection of lung cancers invading the vertebral column remains a major challenge for both surgeons and patients. At Montsouris Mutualiste Institut, we have a nearly 30-year history of surgically treating such cases. With the development of minimally invasive technology, our technique has also evolved over the time. By introducing thoracoscopy for these complex surgical procedures, we have integrated our recently acquired experience in full thoracoscopy technique for major lung resections, with the extensive historical experience for the treatment of lung cancers invading the spine, of both surgical thoracic and orthopedics teams. This article along with the supplemental video demonstrates our current technique for en bloc resection of lung cancers invading the vertebral column, combining full thoracoscopy approach for lung resection with a posterior approach for spine resection. We highlight our tips and tricks to facilitate the procedure. Compared with traditional thoracotomy, this approach is less invasive and feasible. No severe complications occurred during surgery. Our study demonstrates that combining full thoracoscopy for the lung resection to the direct posterior approach for the spine resection, is a safe and effective technique for lung cancers invading the vertebral column.