Background <p>Survival can be prolonged in patients with end-stage heart failure using left ventricular assist devices (LVADs); however, increased longevity raises the risk of developing noncardiac complications, including malignancies requiring surgery.</p> Case presentation <p>A 58-year-old man with an LVAD was referred for the diagnosis and treatment of an undiagnosed nodule in the right upper lobe, which was detected during a preoperative computed tomography (CT) scan, for heart transplantation assessment. CT revealed a 9-mm nodule in the right anterior segment (S³), and an 18F-fluorodeoxyglucose positron emission tomography showed significant uptake, suggestive of lung cancer. A robot-assisted thoracoscopic right S³ segmentectomy was performed. Intraoperative hemodynamic monitoring included an arterial line, a central venous catheter, a pulmonary arterial catheter, and transesophageal echocardiography. The procedure was completed successfully without complications. Pathological analysis confirmed adenocarcinoma, classified as pathological stage T1aN0M0 (Stage IA1). The patient subsequently underwent heart transplantation and LVAD removal on postoperative day 185.</p> Conclusions <p>A patient with lung cancer and an LVAD who was awaiting heart transplantation successfully underwent robot-assisted thoracoscopic right S³ segmentectomy, enabling him to subsequently undergo a heart transplant.</p>