Thoracoscopic apicoposterior segmentectomy, left upper lobe: Posterior approach

Minimally invasive pulmonary segmentectomy allows adequate oncological treatment in selected cases while preserving lung parenchyma and minimizing perioperative morbidity and length of hospital stay. Most lung segments may be resected as segmentectomies or as part of bisegmentectomies (as is the case for the lingula). However, the resection of individual basal segments may be particularly challenging. 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 apicoposterior segmentectomy include proper patient positioning, appropriate positioning of operating trocars, and a standardized technique using a direct posterior approach.