Uniportal thoracoscopic fissureless right lower lobectomy using the suction device trick.

The fissureless technique for lobectomy is considered one of the most useful and effective techniques for patients who have a fused fissure because it offers a relatively low risk of prolonged postoperative air leakage. In the fissureless technique, we use "unidirectional dissection" or "unidirectional stapling" because of the limited angle of approach necessitated by thoracoscopic surgery. Uniportal thoracoscopic surgery has even more access angle limitations than a typical multiportal approach and can be very challenging. When performing fissureless lobectomies, especially lower lobectomies, we have to insert a stapler to divide the bronchus behind which the pulmonary arteries run. It is critically important to avoid injury to the pulmonary arteries as this might cause catastrophic bleeding. We use the "suction device trick" to protect the pulmonary arteries: The suction device is inserted between the lower bronchus and the pulmonary artery, which runs behind it, when stapling, and this ensures that stapling can safely be done without any risk of injury to the pulmonary artery.  In this video tutorial we demonstrate our technique for a uniportal thoracoscopic fissureless right lower lobectomy in a patient with a dense fissure, using the suction device trick, and we explain the nuances of performing it.