International Society For Minimally Invasive Cardiothoracic Surgery

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Robotic Lobectomy With Two Ports Approach And Three robotic Arms
Kook Nam Han, Hyun Koo Kim, Jeong In Hong.
Korea University Guro Hospital, Seoul, Korea, Republic of.

OBJECTIVE: Robotic thoracic surgery has gained acceptance in its surgical accuracy for surgical approach in various thoracic diseases. Usually, we need three- or four-port setup to perform the robotic thoracic surgery. In this video, we introduce the two-ports technique for robotic lobectomy with three robotic arms to reduce the number of ports during robotic thoracic surgery.
METHODS: The patient was a 70-years old female with clinical T2N0M0 non-small cell lung cancer at right middle lobe. For robotic lobectomy, the patient was positioned in lateral decubitus and one lung ventilation anesthesia achieved by a dual lumen endotracheal tube. The robotic system was positioned at the left side of the patient.
RESULTS: We made two incision; a 3-cm incision at 7th intercostal space and another 12-mm incision at 5th intercostal space. A Multi-hole port wound retractor was applied to 3-cm incisional port with CO2 gas insufflation. The camera and one robot arm were docked through the 3-cm port. And another robotic arm was docked to 12-mm incisional port at 5th intercostal space. Pulmonary artery, vein, fissure and bronchus were divided using robotic staplers and we performed complete mediastinal lymph node dissection. Operation time was 175 minutes and there was no operative morbidity.
CONCLUSIONS: Two-ports approach with three arms might be feasible for robotic lobectomy. This technique could be applied in patients with small thoracic cavity who is inappropriate for three- or four-port approach for current robotic technique.


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