Fig. 1

Special techniques for SP-VATS anatomic resection in chronic inflammatory lung disease. The first method is the use of a flexible hook electrocautery for apical or costophrenic adhesion (A, asterisk). The second method is the hilum-first technique, which can be used when the hilum area is relatively less adhesive than the apical area in mycobacterial infection. The LUL apex was still adhesive to the chest wall during hilar dissection (B). All vascular branches to the LUL were divided, followed by LUL bronchus transection (C). The last step was the lysis of the apical adhesion. The third method is the use of a Satinsky vascular clamp for bleeding prevention or control (D, arrows). The fourth method is bronchial stump staged closure when calcified LNs hinder the separation of the bronchus and vascular structure (E and F). B bronchus, C calcified lymph node, LUL left upper lobe, PA pulmonary artery, RLL right lower lobe