How I do VATS segmentectomy: the two-port approach

Abstract

: The authors describe their bi-portal videoassisted thoracoscopic approach to perform anatomic segmentectomies. Operating room setting and details of individual segmentectomies performed through this approach are described. The approach consists of a 3–4 cm anterolateral utility incision performed at the level of 4th or 5th intercostal space and another 1–1.5 cm incision at the level of the 6–7th intercostal space performed just anterior to the posterior axillary line. In general, a wound protector is applied in the utility incision and a trocarless technique is used in the inferior port. The utility and the inferior incisions are used often interchangeably and the type and sequence of instrument introduced through one or the other port change depending on the type of segmentectomy. In general, for upper lobe segmentectomies, the thoracoscope is introduced in the utility incision, while for lower lobe segmentectomies it is positioned in the inferior port. All procedures start with lung inspection to identify the position of the tumour in relation to the preoperative imaging. A pre-emptive intercostal analgesia is performed. Subsequently, the segmentectomy procedure is performed with individual dissection and division of the segmental hilar structures and final division of the intersegmental plane. A systematic lymph node dissection is always performed.