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Gharagozloo et al. Mini-invasive Surg 2020;4:68 I http://dx.doi.org/10.20517/2574-1225.2020.60 Page 5 of 22

Figure 4. Left sided Segmentectomy: begin by dividing the IPL. IPL: inferior pulmonary ligament

scapular line. The Assistant Port #5 uses a 10-12 Versiport trocar and is placed in the 9th intercostal space
and is triangulated between Port #1 and #4.

For the da Vinci Si robot, the bed is angled posteriorly away from the anesthesia machine and the robot
is brought in over the head of the patient. For the Xi system, the robot is brought in from the back and
perpendicular to the patient and the boom is rotated to the proper position.

One of the advantages of the Xi robot is that the surgeon can control the stapling device. We prefer a 30
mm stapler with a white load for the vascular structures, and a blue or green load for the bronchus and the
lung tissue as judged by the size and thickness of the structure.

Instruments: 0° and/or 30° down viewing endoscope, 5 mm Thoracic Grasper, Cadiere Forceps, and Curved
Bipolar Dissector.

For all segmentectomies, begin by dividing the inferior pulmonary ligament and remove station #9, and
station #8 [Figures 4 and 5]. The lung is retracted medially and anteriorly in order to remove lymph
nodes from station #7. We find that pulling the nasogastric tube back above the area of subcarinal
dissections opens the mediastinal space and facilitates the subcarinal and mediastinal dissection. After
the mediastinal dissection, the nasogastric tube is advanced back into the stomach, placed on suction,
and used to decompress the stomach and prevent gastric distension and the resultant elevation of the left
hemidiaphragm. Next, open the pleura anterior to the vagus nerve. Identify the left mainstem bronchus