A robotic fissureless right upper lobectomy using a posterior approach.

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Prolonged air leak is a common complication after lobectomy, particularly when the lung fissure is fused and difficult to dissect.
• The fissureless technique aims to mitigate this risk by avoiding fissure dissection.
• This technique is frequently employed in right upper lobectomies due to the common occurrence of dense fissures between the right upper and middle lobes.

Discussion:

• The fissureless technique requires modifications based on the surgical approach, but the core principle of transecting hilar structures before fissure division remains consistent.
• Robotic right upper lobectomy using the fissureless technique was successfully demonstrated, highlighting specific procedural nuances.
• This approach offers a viable alternative for managing fused fissures during lobectomy.

Key Insights:

• Robotic fissureless right upper lobectomy is feasible and associated with excellent perioperative results.
• The technique led to a short hospital stay (discharged on postoperative day 3) and early chest tube removal (postoperative day 1).
• The patient had a pT1bN0M0, stage 1A2, squamous cell carcinoma, indicating successful oncologic resection.

Outlook:

• Further studies could explore the long-term outcomes and broader applicability of the fissureless technique in various lobectomy procedures.
• Optimization of surgical steps for different approaches may enhance the efficiency and safety of this technique.
• The robotic fissureless technique holds promise for improving patient recovery and reducing complications in lung cancer surgery.