Thoracoscopic superior segmentectomy, left 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, is straightforward, and is versatile enough to allow adaptation in case of unexpected intraoperative findings (such as conversion to lobectomy in the case of positive margins). Key aspects of the procedure include proper patient positioning, appropriate positioning of operating trocars, standardized technique to expose and dissect of the segmental vein, bronchus, and artery, and accurate division of the intersegmental plane and fissure.