Robotic upper division segmentectomy of the left upper lobe without turning the lung

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• The fissureless technique in lobectomy or unidirectional dissection in segmentectomy avoids prolonged air leaks in fused fissures by not dissecting them.
• This method simplifies surgical views, potentially reducing operative time and lung manipulation.
• Its suitability for robotic surgery is explored due to challenges in lung rotation within the robotic thoracic cavity.

Discussion:

• A robotic upper division segmentectomy of the left upper lobe was performed using the fissureless technique.
• The procedure involved detailed explanations of its nuances and execution.
• Challenges in lung parenchyma rotation during robotic procedures were considered.

Key Insights:

• The fissureless technique is a viable approach for robotic segmentectomy, minimizing air leaks.
• Robotic surgery using this technique resulted in a 74-minute console time and minimal blood loss.
• Patients experienced uneventful postoperative courses, with chest tubes removed on the day of surgery and discharge on postoperative day 2.

Outlook:

• The successful application of the fissureless technique in robotic segmentectomy suggests its potential for broader adoption.
• This approach demonstrates feasibility for achieving sufficient surgical margins.
• Further studies may explore its application in various lung resections and patient populations.