M Azari S8-S9 segmentectomy.mp4 (1.36 GB)

Robotic Left Lower Lobe S8+S9 Bisegmentectomy

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posted on 2020-08-10, 21:33 authored by Mohammad R. Azari, Ralitsa Baranowski, Sasha Stamenkovic

The da Vinci Xi robot can be used in performing anatomical lung resections. The highly magnified 3D HD vision with the integrated fluorescence capability, together with the superior articulation of the instruments, makes the Xi robot a superior tool in performing minimally invasive segmentectomies. Intravenous or bronchial ICG (Indocyanine green, a fluorescent dye) assists in identifying the intersegmental planes, which assists with accurate parenchymal resection. Robotic-assisted thoracic surgery (RATS) had comparable perioperative outcome in lung cancer surgery as compared with video-assisted thoracic surgery (VATS) and open surgery (1). Segmentectomy appears to have comparable outcome to lobectomy in patients with no nodal involvement (N0) with tumor sizes less than 2 cm (2).

In this video, the authors present the case of a 76-year-old woman with a 1.9 cm ground glass opacity in the anteromedial segment (S7/S8) of the left lower lobe. A left S8-S9 bisegmentectomy planned for diagnosis and at the same time adequate treatment, provided no evidence of lymph node involvement. The technical aspects of the operation are discussed in the video, and the relevant segmental anatomy is highlighted. The patient had an uncomplicated recovery and was discharged on the second postoperative day. Histopathology confirmed a 19 mm adenocarcinoma, staged as T1b N0 with R0 resection.

References

Hu J, Chen Y, Dai J, Zhu X, Gonzalez-Rivas D, Jiang G, et al. Perioperative outcomes of robot-assisted vs video-assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta-analysis. Int J Med Robot. 2020 May 13.
Bao F, Ye P, Yang Y, Wang L, Zhang C, Lv X, et al. Segmentectomy or lobectomy for early stage lung cancer: a meta-analysis. Eur J Cardiothorac Surg. 2014;46(1):1–7.

Disclosure

Sasha Stamenkovic is a European proctor for Intuitive Surgical Robotic Training (September 2016 to present).