Refining thoracoscopic left S3 segmentectomy by a unidirectional approach

Thoracoscopic anatomical lung resection is today an integral part of the armamentarium of specialized thoracic tertiary referral centers. It is evident that patients benefit from a thoracoscopic approach in the form of a shorter hospital stay, less pain, improved cosmesis, better pulmonary toilet and increased tolerance of postoperative chemotherapy when compared to an open approach (1). While thoracoscopic lobectomy can be considered as a standard procedure, minimally invasive segmentectomy is technically more challenging and demanding, and this procedure is usually reserved for expert centers that have high volume and high expertise video-assisted thoracoscopic surgery programs. Indications for a thoracoscopic segmentectomy are, beside various benign lesions, small peripheral malignant tumors which are less than 2 cm in diameter and in patients with a limited pulmonary reserve. In well trained and experienced hands, thoracoscopic segmentectomy offers equivalent oncological outcomes when compared to thoracoscopic lobectomy in terms of the incidence of local recurrence and long-term survival in stage IA non-small cell lung carcinoma (2)