The author demonstrates the technique for a VATS sleeve lobectomy in an 82-year-old woman. A three-port technique is used, with a 5 mm, 10 mm, and a utility port. To optimize the view, the camera is moved from the anterior to the posterior port during the procedure and back, depending on the region of dissection. Management of mediastinal pleural involvement by a post obstructive pneumonic process, failure of the thymic flap, and subsequent harvest and use of an intercostal flap are all demonstrated.
