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Durand. Mini-invasive Surg 2019;3:35 I http://dx.doi.org/10.20517/2574-1225.2019.31 Page 3 of 9

Figure 1. Port placement according to ICS. The red lines show the partial W design of the port placement; the interrupted lines show the
projected major fissure (up) and diaphragm (down). ICS: inter costal space

curved scissors (Ref. 420178).
- The left hand: fenestrated bipolar forceps (Ref. 420205).
TM
- The third hand (assistant arm): ProGrasp forceps (Ref. 420093).

Two handmade rolled gauzes were inserted, one for each grasper, to ensure a non-direct traction or lung
exposure. A fissure-first technique and sharp dissection were performed. The steps were almost the same
as routine lobectomy, mainly stated as follows:
- Triangular ligament opening and zone 8/9 node harvest.
- Spot of inferior pulmonary vein.
- Zone 7 node harvest and opening the posterior interbronchial zone.
- Spot the artery in the fissure.
- Open the fissure.
- Control and section of the artery (or arteries).
- Control and section of the vein.
- Finish the remaining parenchymal section.
- Bronchus dissection at last and section in pathologic zone.
- Placement of the lobe or segment in the bag.
- Complementary section of the bronchus in healthy macroscopic margin (and then sent to frozen section).
- Bronchial anastomosis.