Retrograde Simultaneous Ligation of Apico-ventral Vessels during VATS RUL.

Thoracoscopic right upper lobectomy is a demanding procedure especially in case of hilar adhesions. Herein, we reported a simple technique of simultaneous ligation of hilar structures to facilitate thoracoscopic right upper lobectomy. After resections of fissures and of hilar lymph nodes, the following structures were sequentially isolated and simultaneously resected in their natural position: V2 + A2 vessels; right upper bronchus; and V1 + V3 + A1 + A3 vessels. This technique was successfully applied in nine patients. The mean hospitalization was 5.2 ± 3.3 days. No intraoperative and major postoperative complications were observed. All patients were alive without recurrence (median follow: 34 months).