Wristed Instrument VATS Right Lower Lobe Sleeve Resection

This is a video of a right lower lobe sleeve resection using the Artisential wristed instruments, including a wristed needle holder. The patient had a right lower lobe tumor that could be seen going up to the right lower lobe orifice. Bronchoscopy had given a needle biopsy demonstrating NSCLC but could not give further characterization.

At surgery, the oblique fissure was perfect and the bronchus could easily be dissected out so using Maryland and Bipolar wristed dissector, the authors performed a right lower lobe sleeve resection and sent it for frozen section. They used 4.0 V-lock to perform the sleeve anastomosis.

This video shows the advantages of wristed instrumentation in VATS over robotics which includes tactile feedback, being by the patient's bedside if there is a bleeding complication, quick changing of instruments, the ability to use multiple instruments, wristed or unwristed, zero set up time, and cost.

As the authors came to the end of the anastomosis, the frozen section came back saying that this was in fact small cell cancer and also there were some cells on the wall of the proximal bronchial resection margin. They decided to instead do a bilobectomy to finish the operation and get a better margin on the bronchus. Final Staging was pT3N1M0PL0R0 and the patient was referred for adjuvant chemotherapy and intracranial irradiation.

Disclosure

The author receives these instruments free of charge. The author received a consulting honorarium in 2019, but no longer receives any payment for the use of these instruments or for the creation of this video.