All procedures were performed with intravenous inhalation combined with anesthesia + double lumen endotracheal intubation. The operation used 3 cm small uni-portal method ( Figure 1 a) : the patient’s lateral side of the midline of the 5th intercostal line 3 cm incision into the thoracoscope (the left side can also choose the 6th intercostal space), elbow cavity mirror suction device, electrocoagulation hook, If necessary, insert a double joint clamp to hold the lobes. At the end of the operation, two 12G microtubules were placed for chest drainage. After the end of one side of the operation, turn over the same side of the same the law. The specific surgical plan is based on the size and location of the bilateral lung GGO, the lung function reserve and the intraoperative frozen examination results. All patients underwent preoperative three-dimensional CT reconstruction and CT-guided methylene blue staining location except central lensions ( Fig. 1 b and Fig. 1 c). In order to avoid the spread of methylene blue, we take the following methods: 1. Surgery as soon as possible after staining is complete; 2. The place marked by methylene blue is next to the lesion, and it will not affect the pathological diagnosis of the lesion. Surgical strategy: ①Pure GGO preferentially choose wedge resection or segmentectomy. ② Peripheral lesions are preferentially treated with wedge resection, and if they are central lesions, lobectomy is performed. ③The lesion is larger than 2 cm and the imaging is considered as an invasive lesion, which will be considered lobectomy. ④Rapid pathology during resection of the lesion is considered as lobectomy for invasive adenocarcinoma.⑤The priority side of the operation is based on the preoperative three-dimensional reconstruction to select the side of the lung tissue that is expected to be resected, such as the wedge resection or segmentectomy. If all are sublobar resection, the right side surgery is preferred.
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