Abstract
to report our initial experience with pulmonary robotic segmentectomy, describing the surgical technique, the preferred positioning of portals, initial results and outcomes. we collected data, from a prospective robotic surgery database, on patients undergoing robotic segmentectomy between January 2017 and December 2018. All patients had lung cancer, primary or secondary, or benign diseases, and were operated on with the Da Vinci system, by the three portals technique plus one utilitarian incision of 3cm. We dissected the hilar structures individually and performed the ligatures of the arterial and venous branches, of the segmental bronchi, as well as a parenchymal transection, with endoscopic staplers. We carried out systematic dissection of mediastinal lymph nodes for non-small cell lung cancer (NSCLC) cases. forty-nine patients, of whom 33 were women, underwent robotic segmentectomy. The average age was of 68 years. Most patients had NSCLC (n=34), followed by metastatic disease (n=11) and benign disease (n=4). There was no conversion to laparoscopic or open surgery, or to lobectomy. The median total operative time was 160 minutes, and the median console time, 117 minutes. Postoperative complications occurred in nine patients (18.3%), of whom seven (14.2%) had prolonged hospitalization (>7 days) due to persistent air fistula (n=4; 8.1%) or abdominal complications (n=2.4%). robotic segmentectomy is a safe and viable procedure, offering a short period of hospitalization and low morbidity.
Highlights
The anatomical pulmonary segmentectomy is becoming more popular among thoracic surgeons in the last decade, as the improvement of tomography technology and the adoption of lung cancer screening with low-dose computed tomography (CT) in high-risk patients have been able of detecting a greater number of lung tumors in initial sages[1]
This study was based on data from our database regarding demographics, diagnosis, type of segmentectomy, operative time, ICU referral, thoracic drainage time, length of hospital stay, histology and morbi-mortality of patients undergoing robotic segmentectomy
The most carried out procedure was the segmentectomy of the upper segments (S6) of the right lower lobe (RLL) and of the left lower lobe (LLL) (n=11, 22.4%), followed by trisegmentectomy (S1/ S2/S3) of the left upper lobe (LUL) (n=9, 18, 3.0%) and the segmentectomy of the posterior segment
Summary
The anatomical pulmonary segmentectomy is becoming more popular among thoracic surgeons in the last decade, as the improvement of tomography technology and the adoption of lung cancer screening with low-dose computed tomography (CT) in high-risk patients have been able of detecting a greater number of lung tumors in initial sages[1]. Anatomical segmentectomy is a more technically difficult procedure. It requires deep knowledge of the lung segmentation and of the anatomical variations, as it involves the precise identification and individual ligation of arteries, veins and bronchi of the resected segment. It has the advantage of sparing lung parenchyma, and preserving its function, which is important in patients with impaired pulmonary function or at high risk of tumor recurrence[4]. The first robotic segmentectomy (R-VATS) was reported in 2007, by Anderson et al.[7]
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