Time to remind old good principles

Introduction of video-assisted thoracic surgery (VATS) of anatomic pulmonary resection brought major changes to various technical aspects of dissection and management of elements of the hilum of the lung. Older techniques of how to manage pulmonary arterial and venous branches with ligatures or sutures were replaced by endostaplers, which theoretically made this technique easier and faster. However, complications occur also during the use of endostaplers as was described by Shimizu et al. (1). The authors analyzed mechanisms of injury of the pulmonary vessels with erroneous lifting and/or twisting of vessels with endostaplers. For older surgeons who gained their experience in the era before introduction of VATS, the conclusions of Shimizu et al. were nothing new—we have all been taught how to be extremely delicate during dissection of the branches of the pulmonary artery, how to avoid stretching vessels during ligation, avoid excessive force during securing sutures and how to eliminate lifting and twisting of the vessels, mentioned by Shimizu et al. With growing experience, minimally invasive thoracic surgeons intuitively learn to be more and more careful with management of pulmonary vessels, especially with pulmonary artery branches, which are exceptionally vulnerable. Such prudent strategy is invariably rewarded with lower and lower intraoperative complications rate