Step 4: Transecting the posterior ascending artery utilizing the anterior utility incision

Depending on the utility incision that has been chosen, the ascending artery to the posterior segment of the right upper lobe may then be controlled through the hilus if an anterior utility incision was elected. The artery is closed and transected between two central clips and one peripheral clip. When a particularly thick fissure makes it difficult to identify the posterior ascending artery, the lobar artery and vein can be isolated, dissected, and secured from the mediastinal approach. By displacing the lung posteriorly, the surgeon can then isolate and sever the bronchus. At this point, stapling the fissure will invariably include and secure the ascending artery as well.