Thoracoscopic anatomical S10 segmentectomy: a posterior approach

Although previous reports have described thoracoscopic segmentectomies, an anatomical thoracoscopic posterior basal segmentectomy is difficult to perform because arteries and bronchi are located deep within the parenchyma in the vicinity of the major fissure and the presence of multiple dissection surfaces. In addition, separation of superior and anterior basal segments occurs to perform this resection from the interlobar fissure. We developed a posterior approach for the resection of the posterior (S10) or the lateral and posterior (S9+10) basal segments based on three-dimensional computed tomography (3D-CT) surgical simulation. To date, we have performed 28 port access anatomical lung segmentectomies using this posterior approach. The primary steps of the surgical procedure have been presented in this article.