International Society For Minimally Invasive Cardiothoracic Surgery

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Kelsey A Musgrove, MD
Mirza N. Ahmad, MD, John E. Mourany, MD, Kelsey A. Musgrove, MD, Ghulam Abbas, MD.
West Virginia University, Morgantown, WV, USA.

OBJECTIVE: Minimally invasive anatomic pulmonary segmentectomy requires intraparenchymal dissection for the exposure of the segmental vessels and bronchi. Robotic platform enables a meticulous dissection due to improve visibility, enhanced dexterity, and increased range of motion. This case video demonstrates a robotic right upper lobe apical segmentectomy using the Xi robot using 4 arm technique and robotic staplers.
METHODS: The patient is a 76 year old man with a history of tobacco use with ground glass opacities followed by serial CT scans and noted to increase in size with more solid component. Metastatic workup was negative. Based on these findings the decision was made to proceed with a robotic right upper lobe apical segmentectomy. The camera port was placed in the posterior axillary line in the 7th intercostal space. Ten centimeters anteriorly a 12 mm port was placed. Ten centimeters posterior to the camera port an 8 mm robotic port was placed. Another 8 mm port was placed posteriorly 3 cm lateral to the spine in the 7th intercostal space just above the diaphragm. The dissection was begun by taking down the inferior pulmonary ligament and opening the pleura over the bronchus intermedius and the right upper lobe bronchus. The lymph nodes between the bronchus and the pulmonary artery were removed. The first branch of the pulmonary artery was dissected and anterior segmental and apical segmental arteries were isolated. The apical segmental branch was transected with curved stapler. The pleura over the hilum was opened. The upper pulmonary vein branches were identified and dissected and apical branch transected with curved white load stapler. The dissection continued on the bronchus and apical segment was transected using a blue load stapler. The parenchyma of the right upper lobe apical segment was transected using a green load stapler. The line of transection was at the level of the bronchial stump.
RESULTS: He was extubated, recovered from anesthesia without difficulty, the chest tube removed, and discharged home without complication two days later. Final pathology revealed stage 1a moderately differentiated adenocarcinoma.
CONCLUSIONS: This video demonstrates the technique used for robotic right upper lobe apical segmentectomy.

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