Technique of thoracoscopic basilar segmentectomy.

STRATEGY FOR THORACOSCOPIC BASILAR SEGMENTECTOMY Although individual basilar segments may be resected, most basilar resections include all 4 segments (ie, segments 7-10). Computed tomography is used preoperatively to determine lesion size, segment location, the presence of adenopathy, and the presence of metabolically active nodal disease (via positron emission tomography), as well as to ascertain that the lesion is not too close to the superior segment to exclude the option of basilar segmentectomy. Anesthesia is administered in the usual fashion, with single-lung ventilation achieved by double-lumen endotracheal tube or bronchial blocker placement. After bronchoscopy and mediastinosopy (when indicated), single-lung anesthesia is established. The patient is positioned in the lateral decubitus position with slight flexion of the table at the level of the hip. This slight flexion provides splaying of the ribs, improving thoracoscopic access and exposure. The chest is then marked for the placement of thoracoscopic incisions, prepped, and draped.