Robotic Right S1 Segmentectomy Extended to S2 and Middle Lobe Wedge Resection Assisted by Multimodal Imaging System

<p>Minimally invasive segmentectomy is becoming a popular operation for the diagnosis and treatment of small pulmonary nodules. It is very technically challenging and the anatomic variations are often unpredictable. The three-dimensional (3D) reconstruction integrated with endoscopic camera imaging, indocyanine green for intersegmental plane definition and nodule location, and radial endobronchial ultrasound and virtual bronchoscopy are technological tools that enhance the efficiency and the safety of complex surgeries with relatively small additional costs. The 3D modeling allows the virtual exploration and virtual resection of the different bronchovascular structures, simulation of safety margins, segmental volumes calculation, and postoperative volumes estimation.<br></p> <p>In this video, the authors present an operation performed for a 65-year-old man who presented with three nodules in the right lung and a history of left upper lobectomy for primary NSCLC. His cancer was successfully treated with robotic imaging-assisted extended segmentectomy (S1 plus S2 wedge) and middle lobe wedge resection. This multimodal imaging-assisted approach allows one to perform more complex operations that would not otherwise be feasible.</p><hr><p><strong>Suggested Reading</strong></p><ol><li>Baste JM, Soldea V, Lachkar S, et al. Development of a precision multimodal surgical navigation system for lung robotic segmentectomy.<a href="https://doi.org/10.21037/jtd.2018.01.32"> <em>J Thorac Dis</em>. 2018;10(Suppl 10):S1195-S1204</a>.</li><li>Le Moal J, Peillon C, Dacher JN, Baste JM. Three-dimensional computed tomography reconstruction for operative planning in robotic segmentectomy: a pilot study. <a href="https://doi.org/10.21037/jtd.2017.11.144"><em>J Thorac Dis</em>. 2018;10(1):196-201</a>.</li><li>Yang Q, Xie B, Hu M, Sun X, Huang X, Guo M. Thoracoscopic anatomic pulmonary segmentectomy: a 3-dimensional guided imaging system for lung operations. <a href="https://doi.org/10.1093/icvts/ivw085"><em>Interact Cardiovasc Thorac Surg</em>. 2016;23(2):183-189</a>.</li><li>Ikeda N, Yoshimura A, Hagiwara M, Akata S, Saji H. Three dimensional computed tomography lung modeling is useful in simulation and navigation of lung cancer surgery. <a href="https://www.ncbi.nlm.nih.gov/pubmed/23364234"><em>Ann Thorac Cardiovasc Surg</em>. 2013;19(1):1-5</a>.</li><li>Baste J-M, Soldea V, Bottet B, Peillon C. Robotic Lower Bilobectomy for an Endobronchial Mass: Suspicion of Carcinoid Tumor. CTSNet, Inc. <a href="https://doi.org/10.25373/ctsnet.5219839">https://doi.org/10.25373/ctsnet.5219839</a> Published July 20, 2017. Accessed December 10, 2018.</li><li>Gillaspie EA, Matsumoto JS, Morris NE, et al. From 3-dimensional printing to 5-dimensional printing: enhancing thoracic surgical planning and resection of complex tumors. <a href="https://doi.org/10.1016/j.athoracsur.2015.12.075"><em>Ann Thorac Surg</em>. 2016;101(5):1958-1962</a>.</li><li>Nagashima T, Shimizu K, Ohtaki Y, et al. (2015). An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography. <a href="https://doi.org/10.1007/s11748-015-0531-1"><em>Gen Thorac Cardiovasc Surg</em>. 2015;63(6):354-360</a>.</li></ol>

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