单孔胸腔镜外侧基底段切除术是技术上最具挑战性的解剖段切除术1-3，特别是当它涉及联合亚段切除术或亚亚段切除术时。因此，详细介绍其技术方面的报道很少。 在这篇多媒体文章中，我们描述了一种非常复杂的单孔胸腔镜联合分段切除术，通过斜裂入路和下肺韧带入路，遵循单向切除 RS9 10bii策略4,5推进程序，利用茎枝法3,6进行节段/亚节段/亚亚节段结构跟踪，并采用双显示法，包括静脉ICG注射法和充气/放气法来识别节间和节间子子节段平面。手术持续 169 分钟，失血约 20 mL。患者分别在术后第 1 天、第 4 天和第 19 天出现活动性血胸和两次自发性气胸，所有这些情况均在治疗后迅速消退。标本的组织病理学检查显示浸润性非粘液性腺癌，手术切缘和淋巴结均为阴性。分期确定为 pT1bN0M0，IA2 期。在14个月的随访期间，没有观察到肿瘤复发或转移的迹象。术后第 6 个月，FVC、FEV1 和 FEV1%pred 分别下降 11.9%、12.5% 和 12.8%。复杂的基底节段切除术需要联合亚节段或亚亚节段切除，例如 RS9 10bii，使用以下方法是可行的：双显示和组合方法。这种方法简化了非常复杂的联合亚段切除术的步骤，避免了广泛的肺切除术的需要。此外，在进行这些联合节段切除术时，精确的解剖解剖对于预防轻微支气管胸膜瘘等并发症至关重要。© 2024。外科肿瘤学会。

Uniportal thoracoscopic lateral basal segmentectomy is the most technically challenging anatomic segmentectomy,1-3 especially when it involves combined subsegmentectomy or sub-subsegmentectomy. Therefore, there are very few reports detailing its technical aspect.In this multimedia article, we describe a very complex uniportal thoracoscopic combined seg-sub-subsegmentectomy of RS9+10bii through the oblique fissure approach and the inferior pulmonary ligament approach, following a single-direction strategy4,5 to advance the procedure, utilizing the stem-branch method3,6 for segmental/subsegmental/sub-subsegmental structure tracking, and employing dual-display method, which comprises the intravenous ICG injection method and the inflation/deflation method, to identify intersegmental and inter-seg-sub-subsegmental planes.The operation lasted 169 min, with approximately 20 mL of blood loss. The patient experienced an active hemothorax and two spontaneous pneumothoraxes on postoperative days 1, 4, and 19, respectively, all of which resolved promptly after treatment. Histopathological examination of the specimen documented invasive non-mucinous adenocarcinoma with negative surgical margins and lymph nodes. The staging was determined as pT1bN0M0, stage IA2. During the 14-month follow-up period, there were no signs of tumor recurrence or metastasis observed. The FVC, FEV1, and FEV1%pred decreased by 11.9%, 12.5%, and 12.8%, respectively, at postoperative month 6.Complex basal segmentectomies, which necessitate combined subsegmental or sub-subsegmental resections, such as RS9+10bii, are feasible using the dual-display and combined approaches method. This method simplifies the steps of the very complex combined subsegmentectomy, averting the need for extensive lung resection. In addition, when performing these combined segmentectomies, precise anatomical dissection is crucial to prevent complications such as minor bronchopleural fistulas.© 2024. Society of Surgical Oncology.