Original article
General thoracic
Robotic Anatomic Segmentectomy of the Lung: Technical Aspects and Initial Results

https://doi.org/10.1016/j.athoracsur.2012.04.086Get rights and content

Background

Robotic lobectomy with radical lymph node dissection is a new frontier of minimally invasive thoracic surgery. Series of sublobar anatomic resection for primary initial lung cancers or for metastasis using video-assisted thoracic surgery have been reported but no cases have been so far reported using the robot-assisted approach. We present the technique and surgical outcome of our initial experience.

Methods

Clinical data of patients undergoing robotic lung anatomic segmentectomy were retrospectively reviewed. All cases were done using the DaVinci System. A 3- or 4-incision strategy with a 3-cm utility incision in the anterior fourth or fifth intercostal space was performed. Individual ligation and division of the hilar structures was performed using Hem-o-Lok (Teleflex Medical, Research Triangle Park, NC) or endoscopic staplers. The parenchyma was transected with endovascular staplers introduced by the bedside assistant mainly through the utility incision. Systematic mediastinal lymph node dissection or sampling was performed.

Results

From 2008 to 2010, 17 patients underwent a robot-assisted lung anatomic segmentectomy in two centers. There were 10 women and 7 men with a mean age of 68.2 years (range, 32 to 82). Mean duration of surgery was 189 minutes. There were no major intraoperative complications. Conversion to open procedure was never required. Postoperative morbidity rate was 17.6% with pneumonia in 1 case and prolonged air leaks in 2 patients. Median postoperative stay was 5 days (range, 2 to 14), and postoperative mortality was 0%. Final pathology was non-small cell lung cancer in 8 patient, typical carcinoids in 2, and lung metastases in 7.

Conclusions

Robotic anatomic lung segmentectomy is feasible and safe procedure. Robotic system, by improving ergonomic, surgeon view and precise movements, may make minimally invasive segmentectomy easier to adopt and perform.

Section snippets

Patients

We retrospectively reviewed prospectively archived data on 17 consecutive patients who underwent robotic pulmonary segmentectomy from January 2008 to December 2010 at the Memorial Sloan-Kettering Cancer Center (New York), the European Institute of Oncology (Milan, Italy), and the Hackensack University Medical Center (New Jersey). The operations were performed by two surgeons (G.V., B.P.). Waiver of authorization for the study was approved by the Institutional Review Board of each institution.

Results

From January 1, 2008, to December 1 2010, 17 consecutive patients underwent robot-assisted lung anatomic segmentectomy. There were 10 women (58.8%) and 7 men (41.2%). Mean age was 68.2 years (range, 32 to 82). Mean operative time was 189 minutes (range, 138 to 240). Distribution of anatomic segmentectomy is listed in Table 1.

There was a preponderance of lower lobe lesions (11 of 17; 64.7%). No conversions to either VATS or thoracotomy were required. Length of stay ranged from 2 to 14 days, with

Comment

Anatomic segmentectomy is the excision of one or more of the bronchopulmonary segments of a lung lobe, with ligation and division of each of the bronchi and vessels serving those segments. Lung segmentectomy was first introduced nearly 70 years ago to treat benign lung tumors [13]. Interest in anatomic lung segmentectomy has increased further after the adoption of high-resolution CT and implementation of lung cancer screening studies, which are increasing the detection rate of small lung

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