Previously, open surgical procedures were preferred in the surgical treatment of PE. In 1998, a new era was opened in the treatment of PE when Nuss et al. reported the minimally invasive treatment of the deformity by passing a rod through the retrosternal area. This method has had the advantages such as fewer complications, shorter hospital stays, and early return to social life. As MIRPE has been implemented, the experience of surgeons has increased and the devices used during the operation have also improved [1,2,3,4,5]. These developments inevitably have brought to mind the following question: Can minimally invasive surgery be performed simultaneously with MIRPE?

When the literature is reviewed, it is seen that open cardiothoracic operations simultaneously with MIRPE are frequently reported. In lung surgery, the number of operations performed simultaneously with MIRPE is rather low. In 2012, Bostancı et al. reported a case of right VATS bullectomy in a 19-year-old. Then Bilgi et al. reported three other cases in 2015. One of these cases was the patient reported in 2012. One of the other two cases was a 24-year-old patient who underwent a right VATS lung biopsy. The other case was a left VATS lower lobectomy at the age of 17. Also, Elkhayat et al. reported a right VATS upper lobectomy in an eight-year-old, in 2018 [2,3,4].

In cases with pathologies in the right lung, VATS was observed to be performed through the incision used for the placement of the pectus bar. In these cases, there was also a port for videoscopy. This port was used to insert the thorax tube. MIRPE, as it is known form, was performed from the right. In our case, a similar method was used for the right VATS bullectomy simultaneously with MIRPE. As reported by Bilgi et al., the left VATS lower lobectomy was performed uniportally in their case. MIRPE was also performed from the right side as it is known [2,3,4]. Although not performed simultaneously, the left VATS bullectomy was performed uniportally in our case. Unlike the cases in the literature, VATS was performed on the patient in the semi-lateral decubitus position. In other cases, VATS was first performed in the lateral decubitus position and then MIRPE was performed in the supine position. We changed the patient’s position in this way to prevent the position of the double-lumen intubation tube from being disrupted. The reason why we preferred the semi-lateral decubitus position in the left VATS bullectomy was to prevent the position of the pectus bar from being affected. There is no data in the literature regarding the superiority of the positions in thoracic surgical procedures performed in patients with pectus bar. Although we think that the supine position is safer for the pectus bar, our preference for the semi-lateral decubitus position in the operation was influenced by the fact that we could reach the apex more easily thoracoscopically by changing the position of the lung.