Thoracoscopic caudal left lower lobectomy in a patient with fused fissure.

A 72-year-old man diagnosed as having primary lung cancer underwent surgical resection using a totally thoracoscopic approach. The thoracoscopic view revealed an incomplete fissure and severe emphysematous change. Therefore, to avoid postoperative air leakage, we decided not to expose the pulmonary artery at the fissure. The inferior pulmonary vein, lower bronchus, and pulmonary artery branches were divided by staplers in a caudal-to-head direction, and then the interlobar area was divided. Postoperative air leakage was not observed.