Robotic anatomic segmentectomy of the lung: technical aspects and initial results

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic lobectomy with radical lymph node dissection represents an advancement in minimally invasive thoracic surgery.
• While video-assisted thoracic surgery (VATS) sublobar resections are reported, robotic-assisted approaches for lung segmentectomy are novel.
• This study details the initial experience with robotic-assisted lung anatomic segmentectomy.

Purpose of the Study:

• To present the technique and surgical outcomes of robotic-assisted lung anatomic segmentectomy.
• To evaluate the feasibility and safety of this minimally invasive approach for lung cancer and metastases.

Main Methods:

• Retrospective review of patients undergoing robotic lung anatomic segmentectomy using the DaVinci System.
• A 3- or 4-incision strategy with a 3-cm utility incision was employed.
• Individual ligation of hilar structures and parenchymal transection were performed, followed by systematic mediastinal lymph node dissection.

Main Results:

• 17 patients underwent the procedure between 2008-2010, with no major intraoperative complications or need for conversion to open surgery.
• Postoperative morbidity was 17.6% (pneumonia, prolonged air leaks), with a median hospital stay of 5 days.
• Pathology revealed non-small cell lung cancer (8), carcinoids (2), and metastases (7), with 0% postoperative mortality.

Conclusions:

• Robotic anatomic lung segmentectomy is a feasible and safe procedure.
• The robotic system enhances ergonomics, surgeon visualization, and precision.
• These advantages may facilitate the adoption and performance of minimally invasive segmentectomies.