Three-dimensional guided robotic-assisted thoracic surgery is increasingly recognized as a leading technique for undertaking the most complex pulmonary resections, providing high-definition three-dimensional visualization, advanced instrument control and tremor-free tissue handling. Compared with open thoracotomy, the robotic platform offers reduced perioperative complications, shorter hospital stays and faster patient recovery. Nevertheless, sublobar resections, such as segmentectomies, remain both anatomically intricate and technically challenging, particularly when resecting multiple segments, as in this left S1 and S2 segmentectomy. Incorporating three-dimensional reconstruction imaging facilitates comprehensive preoperative evaluation of bronchovascular anatomy, enabling tailored operative planning and therefore more precise dissection. Despite these benefits, the consistent use of three-dimensional virtual modelling in thoracic surgery is still limited and under-represented within the current literature. This video tutorial constitutes the fifth entry in the Segmentectomies Made Easy atlas and showcases a robotic left S1, S2, S3 trisegmentectomy performed for a primary pulmonary lesion in the S1 segment in the left upper lobe. Preoperative three-dimensional imaging identified the lesion to be deeply centrally located and greatly informed our surgical approach. This video tutorial delivers a structured, step-by-step overview of the operation, from port placement through to vascular division and extensive complex anatomical delineation, highlighting the ways in which three-dimensional visualization dictates surgical precision, enhances intraoperative decision-making and contributes to optimized outcomes for robotic-assisted thoracic surgery.
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