My Favourite Segmentectomy. Robotic S2+S6 Bisegmentectomy for an Interfissural Right Sided Tumour
I was very nervous about taking on this case as normally
when you do a segment 6 or segment 2 resection the first move is to go in the
fissure then you an easily dissect out all the anatomy. But with the tumour in
the fissure that was not going to be possible. So I knew that I would have to
find the Artery, bronchus and vein to the apical segment of the right lower
lobe all from posteriorly to be able to successfully transect them and then
allow the segmental fissure to be opened up which would allow access to S2.
(the posterior segment of the right upper lobe)
Thankfully with the great vision of the Intuitive Xi, careful dissection and removal of all lymph nodes and also with 3D reconstruction performed by Ben Waterhouse using the Horos software as taught to us by Brian Mitzman's videos, we were able to perform this segmentectomy very nicely !
Certainly my take away learning points included :
1. Take away all lymph nodes and do as much lymphadenectomy as possible first.
2. Dissect distally into all vessels to identify the anatomy and also the other segmental structures.
3. Use Bronchial inflation and ICG to further assist identification of the intersegmental planes.
4. Get a really nice 3D reconstruction CT scan as your roadmap.