1. Technical Tricks to Facilitate Totally Endoscopic Major Pulmonary Resections 
Dominique Gossot, MD 
The Annals of Thoracic Surgery 
Volume 86, Issue 1, Pages (July 2008)
DOI: /j.athoracsur
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Example of the limitation of a direct viewing endoscope (0°) during the division of the fissure during thoracoscopic right upper lobectomy. (A) With a 0° scope, the tip of the endostapler is out of the vision field, (B) although it can be perfectly controlled with a deflectable scope.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
High definition deflectable tip thoracoscope allows performing the whole procedure with a single endoscope and avoids the problems related to tangential vision.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Opening the fissure during a thoracoscopic middle lobectomy using 3-mm grasping forceps for better exposure. (ML = middle lobe; RLL = right lower lobe; RUL = right upper lobe.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Control of the lobar bronchus during a thoracoscopic right upper lobectomy using deflectable grasping forceps to help pass around the bronchus. (RLL = right lower lobe; RUL = right upper lobe.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
Clamping the parenchyma to determine the intersegmental plane is achieved with a dedicated endoscopic 5-mm clamp (in this case, during a thoracoscopic lingulectomy for carcinoid tumor).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

7. Fig 6
Facilitating the passage of the endostapler for fissure division during a thoracoscopic left basilar segmentectomy using a thin suction catheter as a guide. The fine tip is first passed behind the vessel and pulled out to attract its basis connected to the stapler jaw. (LLL = left lower lobe; LUL = left upper lobe.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

8. Fig 7
Initiating fissure division using ultrasonic shears during a thoracoscopic left lower lobectomy. (LLL = left lower lobe; LUL = left upper lobe.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions