We describe our technique of basilar segmentectomy by using a totally thoracoscopic approach without utility incision. We have performed 65 anatomical segmentectomies by using this approach. Nineteen of these were basilar segmentectomies. On the basis of this experience, we report useful technical details and our results. There was 1 conversion to thoracotomy because of inflammatory and fused fissure (1.5%). In the 18 remaining patients who had a totally endoscopic resection, the mean operative time was 191 minutes (range, 116-315 minutes). The mean operative blood loss was 73 mL (range, 10-150 mL). The postoperative course was uneventful in all but 1 patient who developed pulmonary edema that resolved after 2 days. Chest tubes were removed after a mean time of 2.8 days (range, 2-5 days), no patients had a prolonged air leak, and the mean postoperative stay was 6.1 days (range, 3-14 days).