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Page 8 of 22 Gharagozloo et al. Mini-invasive Surg 2020;4:66 I http://dx.doi.org/10.20517/2574-1225.2020.53

Figure 8. RS1 segmentectomy: Dissection of the A1 branch of the PA. View of the SVC, AZ, and the right main PA. AZ: azygous vein; PA:
pulmonary artery; SVC: superior vena cava

dissection of the pulmonary artery (PA) as well as the right upper lobe bronchus. In addition, the removal
of Station #11 nodes facilitates the completion of the posterior fissure.

Next, the lung is retracted posteriorly to expose the anterior hilum. The dissection is carried down between
the hilar structures and the phrenic nerve. The phrenic nerve is swept down to remove the #10R lymph
node. The bifurcation between the middle and upper lobe veins is dissected. It is best to encircle the entire
upper lobe vein off the underlying PA using the Cadiere Forceps in the left arm and pass a red rubber vessel
loop to elevate the vein. This makes the dissection of the middle lobe vein easier. Following the dissection
of the middle lobe vein, the Cadiere Forceps is passed under the elevated upper lobe vein, and the vessel
loop is released and regrasped, thereby isolating the upper lobe vein. Dissection is continued and the
proximal main PA is exposed as it emerges from the pericardium.

Right upper lobe anatomic apical segmentectomy (S1)
Following the complete mediastinal nodal dissection, the lung is retracted in a caudal direction and the A1
PA branch is identified, dissected away from the descending branch of the right PA, and divided using a
stapler with a vascular cartridge [Figures 8 and 9]. Next, the lung is retracted posteriorly and the V1 branch
of the superior pulmonary vein is identified [Figure 9]. The N1 nodal bundle which resides between the V1
and the PA is removed. V1 is encircled and divided with a stapler with a vascular cartridge. Although many
surgeons do not anatomically isolate and divide the segmental vein separately, isolation and division of the
vein helps in opening the operative space and may be preferred. Division of the vessels and removal of the