Robotic Right Upper Lobe Anterior (S3) Segmentectomy: Case Discussion and Technical Aspects
The advent of low dose CT scans for lung cancer screening
has resulted in increased detection of small lung nodules concerning for
malignancy. Based on the location, some of these nodules may not be amenable to
diagnostic transthoracic biopsy or wedge resection. In this scenario, a
segmentectomy may be performed for diagnostic purposes.
In-depth knowledge of the venous and arterial anatomy is crucial when
performing segmental operations. Specifically, for right upper lobe anterior
segmentectomies, one should be vigilant during dissection of the minor fissure
and visualize the central vein and posterior segmental veins prior to division
of the anterior segment vein and completion of the fissure. The authors believe
that the success of this operation is contingent upon identifying and
preventing injury to these critical structures, and thus avoiding the need for
a more extensive resection.
The authors describe the case of a 76-year-old male with a significant smoking
history, who presented with an anterior right upper lobe nodule on CT scan. The
patient underwent a transthoracic need biopsy, as well as a transbronchial
biopsy which were both non-diagnostic. Based on the location of the nodule, the
aim was to perform a robotic assisted right upper lobe anterior segmentectomy
(S3) for diagnosis and proceed with a completion right upper lobectomy if the
intra-operative pathology confirmed malignancy. Technical details of the
operation and relevant anatomical considerations are described in the video.
Once a pathological diagnosis of NSCLC was confirmed, completion right upper
lobectomy and mediastinal lymph node dissection were performed. The patient had
an uneventful postoperative course. Final pathology revealed moderate to poorly
differentiated squamous cell carcinoma, pathological stage T1c N0, for which no
adjuvant therapy was recommended.
In conclusion, for small central nodules not amenable to diagnostic biopsy or
wedge resection, a segmentectomy may be initially performed for pathological
confirmation of malignancy, prior to oncologic lobectomy.
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