Robotic Left Lateral Basilar (S9) Segmentectomy

This video presents a robotic left lateral basilar (S9) segmentectomy. The patient was a fifty-six-year-old female with a sixty-pack-per-year smoking history and a two-year history of left lower lobe nodule contained to the lateral basilar segment. The nodule demonstrated recent growth and had developed a central solid component. The patient’s preoperative FEV1 was 113 percent with a DLCO of 80 percent. The patient reported significant dyspnea on exertion. A robotic left lateral basilar segmentectomy was recommended.

The operation began with dissection of the inferior pulmonary ligament and mediastinal lymph node. The left pulmonary artery was then dissected, exposing the segmental arteries. This included the posterior apical, lingular, superior segmental, anterior basilar, posterior basilar, and lateral basilar arteries. The lateral basilar artery was divided, followed by division of the lateral basilar bronchus and vein. Indocyanine green (ICG) was used to assist in delineation of the S9 segment. Intraoperative frozen section analysis showed the nodule was 7 mm from the anterior staple line, and an additional wedge resection was performed along the anterior basilar segment. Final pathology demonstrated minimally invasive lung adenocarcinoma in a background of adenocarcinoma in situ and zero out of six lymph nodes were positive after sampling of stations 5L, 7, 9L, 10L, 11L, and 13L. Final pathologic stage was T1a, N0, M0. The patient was seen for her postsurgical follow-up and was recovering appropriately with minimal worsening of her dyspnea symptoms.

Reference(s)

1. Nomori H, Okada M. Illustrated Anatomical Segmentectomy for Lung Cancer. Springer; 2012.

2. Miyata Y, Okada M. Hybrid video-assisted thoracic surgery basilar (S9-10) segmentectomy. Semin Thorac Cardiovasc Surg. 2011;23(1):73–7.