Abstract
Anatomic pulmonary segmentectomy and mediastinal nodal dissection have been advocated in patients with smaller tumors or patients with limited pulmonary reserve. The overall five-year survival and lung cancer-specific five-year survival following anatomic segmentectomy have been shown to be equivalent to lobectomy. Robotic surgical systems have the advantage of magnified high-definition three-dimensional visualization and greater instrument maneuverability in a minimally invasive platform. Robotics can facilitate the dissection of the broncho-vascular structures and replicate the technique of segmentectomy by thoracotomy. Greater experience with the robotic platform has resulted in a reproducible technique. The Technique of Robotic Anatomic Segmentectomy Part I outlines a stepwise approach to robotic segmentectomy of S1, S2, S3, S4, S5, S6, and S7-S10 of the right lung. The Technique of Robotic Anatomic Segmentectomy Part II outlines a stepwise approach to robotic segmentectomy to the left lung.
Highlights
Controversy about sublobar lung resection is largely attributed to The Lung Cancer Study Group’s prospectively randomized study in 1995 which showed that sublobar resections had 75% increased recurrence, 30% increased overall death, and 50% increased cancer-related death compared to lobectomy[1,2]
Prospective studies comparing wedge resection and anatomic segmentectomy for T1N0 disease are in progress, anatomic segmentectomy may be a better oncologic procedure in patients with more advanced disease
The long-term results of robotic anatomic segmentectomy from our Institution were reported by Nguyen et al.[19]
Summary
Anatomic segmental resection (segmentectomy) is the excision of one or more bronchopulmonary segments of a pulmonary lobe with individual ligation and division of the corresponding broncho-vascular www.misjournal.net. The most posterior arm is used to retract the upper lobe inferiorly during dissection of Stations #2R and #4R, clearing the space between the superior vena cava anteriorly, the trachea posteriorly, and the azygos vein inferiorly [Figure 6]. Following the complete mediastinal nodal dissection, the lung is retracted in a caudal direction and the A1 PA branch is identified, dissected away from the descending branch of the right PA, and divided using a stapler with a vascular cartridge [Figures 8 and 9]. The lung is retracted posteriorly and the V1 branch of the superior pulmonary vein is identified [Figure 9].
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