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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 15 of 22

Figure 20. Lingulectomy (LS4, LS5): LPA is encircled and elevated with a vessel loop and divided with a stapler carrying a white
cartridge. LPA: lingular pulmonary artery

Next, the lung is retracted posteriorly, and the anterior hilum is approached. The space between the
superior and inferior pulmonary veins is developed and the nodes are removed. The superior pulmonary
vein is dissected away from the underlying pulmonary artery, encircled with a vessel loop, and elevated.
After the entire superior pulmonary vein is dissected, the Lingular vein(s) are identified, encircled, elevated
with a vessel loop, and divided with a vascular stapler. Then, the anterior aspect of the oblique fissure is
divided by passing a stapler with a blue cartridge from an anterior to posterior direction, heading toward
the space between the Lingular artery and the inferior pulmonary artery. This enables easy access to the
Lingular pulmonary artery which is encircled, elevated with a vessel loop, and divided with a stapler
carrying a white cartridge [Figure 20]. Division of the fissure also enables access to the Lingular bronchus.
The Lingular bronchus is encircled and elevated with a vessel loop; the anesthesiologist removes any
indwelling suction catheters and the bronchus is divided with a stapler using a green cartridge [Figure 21].
Finally, using the techniques which have been outlined earlier, the intersegmental fissure between S1 + S2,
S3, and the Lingula are identified [Figure 22]. The lung parenchyma is then divided with multiple firings of
a stapling device with a blue or green cartridge.

Robotic left lower lobe anatomic superior segmentectomy (S6)
Port placement and instruments are similar to the left upper lobe segmentectomy procedures.

Following the complete mediastinal dissection which has been outlined previously, the pulmonary artery
is identified in the oblique fissure. The subadventitial plane overlying the pulmonary artery is entered, and