Uniportal VATS fissure-based approach to segments 9 and 10

Posterolateral bisegmentectomies of the lower lobe (segments 9 and 10) are challenging procedures when performed by uniportal VATS, primarily for the following reasons: first, the cuboidal shape of the basilar segments makes the identification of the intersegmental plane difficult, and second, the segmental arterial and venous supplies are deeply located and highly variable.  The fissure-based dissection, combined with the intersegmental tunneling method, emerges as the safest approach to accomplish accurate identification of the vascular pattern and radical removal of interlobar lymph nodes. The purpose of this video tutorial is to illustrate the technical aspects of the fissure-based uniportal left S9+10 segmentectomy using the intersegmental tunneling method.