The patient depicted in the video presentation is an 8 year old with a number of medical problems including immune deficiency, hyperthyroidism, adrenal insufficiency, vitiligo and alopecia as well as chronic consolidation of the right middle lobe with bronchiectasis. She has been evaluated by a number of pulomonary specialists who have recommended right middle lobectomy as it has been felt that the consolidation in the right middle lobe is irreversible. The patient was placed in the left lateral decubitus position and endotracheal anesthesia was administered with a double lumen endotracheal tube. Following collapse of the right lung, the initial incision was 5 mm in length and was made in the fifth intercostal space. Following insufflation with carbone dioxide to a pressure of 6 torr, a 70 degree angle telescope was introduced through this cannula. Two additional 5 mm cannulas were then introduced ? one in the fourth intercostal space and one in the seventh intercostal space. The procedure was performed uneventfully and required approximately two hours of operative time. The estimated blood loss was 15-20 cc and she was discharged on her first postoperative day. She has continued to recover uneventfully.