VATS Left Lower Lobe S7-8 Segmentectomy

This video demonstrates a thoracoscopic segmentectomy of segments seven and eight of the left lower lobe in a 79-year-old male enrolled in a lung cancer screening program, in which a pulmonary nodule was detected. An endoscopic biopsy confirmed pulmonary adenocarcinoma, and positron emission tomography (PET) imaging revealed a standard uptake value (SUV) of 4.2 without evidence of other hypermetabolic lesions. Pulmonary function tests showed a reduced respiratory reserve (forced expiratory volume in one second (FEV₁), 52 percent; diffusion capacity of the lungs for carbon monoxide (DLCO) 45 percent). Given these limitations, a segmental resection of segments seven and eight was selected as the operative strategy, despite the tumor exceeding two centimeters in size. 

Thoracoscopic access was first established, and the inferior pulmonary ligament was divided to retrieve lymph nodes from station nine. The fissure was then completed to improve visualization of the interlobar artery and bronchial structures, allowing for the dissection of station 11 lymph nodes. The venous branches draining segments seven and eight were isolated with a vessel loop and divided using a thoracoscopic stapler. Attention then turned to the basal trunk, where the arterial branches supplying segments seven and eight were carefully dissected and divided. The corresponding bronchus was encircled with an elastic band for traction and subsequently divided. The intersegmental plane was delineated using the inflation–deflation technique, and a subcarinal lymph node (station seven) was sampled for staging. Parenchymal division was achieved with staplers along the intersegmental plane, preserving the remaining lower lobe. 

The specimen was retrieved in an endoscopic bag, and upon reaeration, the lung expanded appropriately. This concluded the thoracoscopic segmentectomy of segments seven and eight of the left lower lobe, performed with systematic lymph node dissection. 

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