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the clear 4K HD images and could re-watch the operation many times. Furthermore, there was also a
concurrent decrease in postoperative complication rates. Therefore, our microanatomy-based concept
appears to be useful not only for accurate and quick UMLD, but also for young surgeons to master the
procedure efficiently.

Now, in our institution, we can conduct three types of MIE [thoracoscopic surgery, mediastinoscopic
surgery, and robotic-assisted surgery (RAMIE)], and the rate of RAMIE has recently been increasing.
We believe that RAMIE is an advanced form of thoracoscopic surgery and our microanatomy-based
standardization approach could be similarly applied. Furthermore, we expect that this standardization will
make much progress using the joint function and shake reduction system unique to RAMIE.

In conclusion, microanatomy-based standardization using a 4K ultra-HD system enabled quicker and more
precise UMLD despite an increase in the number of surgeries performed by less experienced operators.

DECLARATIONS
Acknowledgments
The authors would like to thank FORTE (https://www.forte-science.co.jp/) for English language review.

Authors’ contributions
Conception and design: Shirakawa Y
Data collection: Shirakawa Y, Maeda N, Tanabe S
Establishment of study materials or enrolment of patients: Shirakawa Y, Noma K, Tanabe S, Sakurama K,
Fujiwara T
Data scrutiny, analysis, and clarification: Shirakawa Y
Writing and revision of the manuscript: Shirakawa Y
Study supervision: Fujiwara T
Read and agree with the final manuscript: Shirakawa Y, Noma K, Maeda N, Tanabe S, Sakurama K,
Fujiwara T

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

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