For the complete thoroscopic approach, typically, five ports are required. Alternatively, the axillary port, which can be extended to 4 to 5 cm for the “access” incision technique and 1–3 thoracoport incisions can be used. However, in spite of the complete thoracoscopic approach, the axillary insicion will likely still need to be extended to allow for removal of the specimen.

We prefer to perform the completely thoracoscopic approach and place two posterior ports that are used for retraction and three anterior ports for dissection and visualization, although any of the ports can be used for dissection, retraction, or visualization. The three anterior ports are placed along the anterior
axillary line; the first is a video port placed at the sixth to seventh intercostal space and the second in the midchest level. The third and most superior port is placed at the axillary hair line, typically at the second to third intercostal space. It is through this port that the specimen will be delivered, as stated, the port site that may need to be enlarged. The two posterior ports are placed 10 to 15 cm apart and are in the line of the middle distance between the posterior portion of the scapula and the posterior spinous processes. For upper lobes, these posterior ports are somewhat higher than for inferior lobes. After the ports are placed, any of them can be used for video examination or dissection.