When performing video-assisted lobectomy for lung diseases, the incisi
onal strategy for the minithoracotomy and two trocar ports is crucial
for successful completion of the procedure. Our strategy is primarily
determined according to three principles: The hilar bronchovascular st
ructures should be easily accessible; the minithoracotomy should be re
adily convertible to a standard open thoracotomy; and the wounds shoul
d create only Limited damage. To enable a quick conversion, the minith
oracotomy incision must be placed on the scheduled posterolateral thor
acotomy line regardless of its location. The entire procedure is best
managed when the minithoracotomy is placed anteriorly on the inframamm
ary line in the fourth intercostal space for upper and middle lobectom
ies and posteriorly over the auscultation triangle in the fifth interc
ostal space for lower lobectomies. Two trocars are used for thoracosco
py and retraction. The sequence of each operative step should be deter
mined by the lobe to be resected. This lobe-specific incisional and op
erative strategy based on anatomical considerations not only facilitat
es the safe dissection of the hilum but also enables a rapid conversio
n to a standard posterolateral thoracotomy.