Complex Robotic-Assisted Right Lower Lobe Basilar Segmentectomy in the Setting of Prior Laryngectomy

Introduction. Operating in a post-surgical field has inherent technical challenges. Often, tissue preservation is important given prior excision leaving remaining anatomy limited. In select cases, the enhanced abilities afforded by robotic-assisted surgery allows for critical tissue preservation compared to standard laparoscopic techniques.

Methods. A 76 year old male presented with an incidentally found enlarging, hyper-metabolic 2.2 cm right lower lobe nodule. He had a pertinent history of laryngectomy for proven squamous cell carcinoma of the supraglottis. Following preoperative clearances, he was booked for elective robotic-assisted pulmonary resection.

Results. Use of robotic minimally invasive surgery allowed for clear delineation of structures and the dissection required for tissue sparing resection in the post-operative surgical field. The procedure was able to be completed without complication and without requirement for lobectomy as may have been required otherwise. The patient was discharged home on post-operative day two in good condition. Surgical pathology showed moderately differentiated squamous cell carcinoma.

Conclusions. The use of robotic technology allows for technical advancement within the field of minimally invasive surgery, allowing for tissue preserving procedures like those demonstrated in the video. These procedures are critical in certain instances, such as the post-operative surgical field in the patient scenario discussed. We hope that the information demonstrated will contribute to the overall improvement of technical ability in the field of complex pulmonary surgery.

Key Words: segmentectomy, lobectomy, lung cancer, squamous cell carcinoma, laryngectomy, robotic surgery, minimally invasive surgery, tissue sparing surgery