Uniportal ligamentum-based approach to posterolateral segments 9 and 10.

Uniportal VATS posterolateral segmentectomy (S9 and S10) can be an option for treatment of early-stage lung cancer or in cases of central metastases.  Lower lobe segmentectomy is challenging because the pyramidal shape of the basilar segments makes the identification of the intersegmental plane difficult, and the segmental arterial and venous supply is highly variable. Although identifying the segmental arterial branches is easier with a fissure-based technique, the ligamentum-based approach has emerged as a valid and safe alternative in cases of fused fissure.  This video tutorial illustrates the technical aspects of the uniportal VATS ligamentum-based S9+10 segmentectomy of the right lower lobe.