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Robotic-Assisted Right Upper Lobectomy with En-Bloc Chest Wall Resection for a T3 Adenocarcinoma
Nguyen M. Le, MD, Laurence N. Spier, MD, Richard S. Lazzaro, MD.
Northwell Health - Lenox Hill Hospital, New York, NY, USA.

OBJECTIVE: This video demonstrates a robotic-assisted right upper lobectomy with en-bloc chest wall resection for a T3 tumor.
METHODS: An 82-year-old female was found to have a biopsy-proven adenocarcinoma of the right upper lobe which was attached to the chest wall. PET revealed no extrathoracic or mediastinal disease. The patient was placed in left lateral decubitus. Five ports were used - four for the robot and one access port. A Gigli saw was used to resect part of the involved rib intrathoracically. A robotic-assisted right upper lobectomy with en-bloc chest wall resection and mediastinal lymph node dissection was performed without complication.
RESULTS: Final pathology revealed a pT3N0 adenocarcinoma, solid pattern predominant with lepidic and acinar patterns. Tumor invaded through the visceral pleura into the parietal pleura. The bronchial and vascular margins were clear. Fourteen lymph nodes from seven levels were negative. The patient was discharged on POD3.
CONCLUSIONS: Robotic-assisted lobectomies for T3 tumors invading the chest wall are safe and feasible.


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