Technical aspects of biportal video-assisted thoracoscopic fissureless right S1+2 segmentectomy of the lung

The technical aspects of the biportal anterior approach for right apical and posterior segmentectomy are described. The approach is a fissure-less one. The first step is the division of the apical vein anteriorly, followed by the dissection and division of the apical artery. This step will expose the apical B1 segmental bronchus, which is divided. Following this division, the ascending posterior segmental branch of the pulmonary artery (rec A2) is exposed and divided. The next step is the division of the B2 segmental bronchus. The fissure is not violated in any of the steps presented in this technique. Finally the intersegmental plane between the two segments and the anterior segment is completed along the inflation-deflation line.