Fissureless Fissure-Last Thoracoscopic Left Lower Lobectomy

The author believes that a fissureless fissure-last technique for anatomical video-assisted thoracoscopic (VATS) resections is more effective than conventional VATS, with less air leak and shorter length of hospital stay. While there are several articles explaining how the fissureless fissure-last technique can be applied to both lobes in both open and thoracoscopic approaches, there are very few addressing the use of this technique in the lower and middle lobes. This video demonstrates the technical details of a thoracoscopic left lower lobectomy utilizing the fissureless fissure-last technique.

An 80-year-old patient was diagnosed with squamous cell carcinoma in the left lower lobe. The tumor was preoperatively measured as larger than 7 cm, and had infiltrated the incomplete fissure and a small portion of the upper lobe. Staging examinations (positron emission tomography, computed tomography, and cranial magnetic resonance imaging) revealed enlarged mediastinal lymph nodes, but no distant metastasis. Prior to the main surgery, video-assisted mediastinal lymphadenectomy (VAMLA) was performed and no mediastinal lymph node metastasis was detected. The operation was performed using a classic three-port approach.