Thoracoscopic left apical bisegmentectomy.

Minimally invasive pulmonary segmentectomy allows adequate oncologic treatment in selected cases while preserving lung parenchyma and minimizing perioperative morbidity and length of hospital stay. It may also be ideal for removing benign obstructive lesions. Most lung segments may be resected as segmentectomies or as partial bisegmentectomies (as is the case for the lingula). Although several variations of minimally invasive pulmonary segmentectomy have been described, I favor a fully thoracoscopic multiport approach that generally allows direct access to the segmental structures, is usually straightforward, and is versatile enough to allow adaptation in case of unexpected intraoperative findings (such as conversion to lobectomy if positive margins are found). Key aspects of the procedure include proper patient positioning, appropriate positioning of operating trocars, standardized technique to expose and dissect the bisegmental vein, artery, and bronchus, and accurate division of the intersegmental plane.