Surgical technique for uniportal VATS right S10 segmentectomy with the pulmonary ligament approach, performing the...

Segmentectomy requires the transection of the pulmonary artery, pulmonary vein, and bronchus in the segment. These are generally dissected from the center to the periphery. In S10 segmentectomy, the textbook procedure is to address A10 and B10 from the interlobar side. However, this procedure requires some dissection of the lung parenchyma up to the branching point of A10 and B10, which increases the risk of alveolar air leak. In this report, we performed a uniportal video-assisted thoracoscopic surgery (VATS) right S10 resection from the pulmonary ligament side without interlobar intervention. Our method differs from existing reports in that it performs the intersegmental division last. When the lung is pulled cephalic and ventral after V10 is dissected, B10 posteriorly becomes clear. By dissecting B10, the accompanying A10 can be confirmed. S10 resection can be performed by the pulmonary ligament approach without going through the interlobar. This technique is consistent with the principles of uniportal VATS, which involves dissection from caudal to cephalad, and is also applicable to S9 and S9+10 resection. Regarding the intersegment division using staplers in the complex segmentectomy of the lower lobe, the key is the consciousness such that firstly 4 and 8 o'clock direction, and lastly 0 o'clock of a pattern reminiscent of the Mercedes-Benz emblem. In uniportal VATS, it is most effective to introduce the right-hand device from the 3 to 7 o'clock direction of the screen.