Standalone Totally Thoracoscopic Left Appendage Clipping: Safe, Simple, Standardized.

Totally thoracoscopic standalone left atrial appendage exclusion has become a valid treatment option for stroke prevention in patients with a contraindication to anticoagulants. As with most other video-assisted surgeries, this procedure requires appropriate patient and port positioning to obtain the most advantageous working angles and standard thoracoscopic skills. Furthermore it is mandatory to have a closure device specifically designed for the appendage to guarantee efficacy and safety and to optimize surgical placement that allows the best clinical outcomes. Here we describe the surgical technique of a unilateral left-sided thoracoscopic approach for surgical exclusion of the appendage on the beating heart.