Trans-inferior-pulmonary-ligament VATS basal segmentectomy: application of single-direction strategy in segmentectomy of left S9+10

With the extensive application of low-dose computed tomography (CT) screening in lung cancer diagnosis, the detection of early stage lung cancer has increased remarkably (1). Although full lobe resection is the mainstream treatment of early-stage non-small cell lung cancer (NSCLC), limited resection, such as anatomic segmentectomy, plays an important role in the treatment of patients with both stage IA NSCLC and those unable to tolerate lobectomy because of compromised medical conditions (2-7). The intentional use of anatomic segmentectomy for the treatment of small peripheral lung cancers was first described by Jensik et al. in 1973 (8). Despite the rapid development in video-assisted thoracic surgery (VATS) in the past two decades, the VATS segmentectomy still poses a few technical challenges. For our thoracoscopic segmentectomy practice, we adopted the strategy of single-direction thoracoscopic lobectomy that was designed by Liu et al. (9). Taking the left basal S9+10 segmentectomy as an example, we described the technical characteristics of single-direction segmentectomy through an inferior pulmonary ligament approach (Figure 1)