A robotic left S6 and S1/2c segmentectomy using the lung-inverted approach

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Traditional pulmonary segmentectomy involves dividing pulmonary arteries at the fissure, risking injury and prolonged air leak in fused fissures.
• Fused fissures in pulmonary segmentectomy pose challenges, potentially leading to inadvertent pulmonary artery injury and prolonged air leak.

Discussion:

• The lung-inverted approach, facilitated by robotic surgery's visualization, bypasses fissure dissection for segmentectomy.
• This method requires precise anatomical understanding of inverted hilar structures, including pulmonary vessels and bronchi.
• Preoperative 3D CT broncho-angiography is valuable for recognizing the spatial relationships of hilar structures.

Key Insights:

• Robotic lung-inverted segmentectomy successfully performed on left S6 and S1+2c.
• This approach avoids fissure dissection, mitigating risks associated with fused fissures.
• Achieved a short console time of 57 minutes, potentially due to reduced lung manipulation.

Outlook:

• The lung-inverted approach may offer a safer and more efficient alternative for specific pulmonary segmentectomies.
• Further studies could explore the broader applicability and long-term benefits of this technique.
• Enhanced anatomical visualization through 3D CT is crucial for successful implementation.