Completely thoracoscopic superior segmentectomy of the right lower lobe

Minimally invasive pulmonary segmentectomy allows adequate oncologic treatment in selected cases while preserving lung parenchyma and minimizing perioperative morbidity and length of hospital stay.   Although several variations of minimally invasive pulmonary segmentectomy have been described, I favor a fully thoracoscopic multiport approach that allows direct access to the segmental structures, and is straightforward and versatile enough to allow adaptation (such as conversion to lobectomy in the case of positive margins) if there are unexpected intraoperative findings.   Key aspects of the procedure include proper patient positioning, appropriate positioning of operating trocars, standardized technique to expose and dissect the segmental vein, bronchus, and artery, and accurate division of the intersegmental plane and fissure.