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Updated: Jan 7, 2026
Subcostal Specimen Removal in Completely Portal Robotic Lobectomy
Published on: April 19, 2024
Surgical Outcomes of Subxiphoid Thoracoscopic Complex Basilar Sublobar Resection Versus Lower Lobectomy: A
Dorian Rojas1,2, Jules Iquille1, Bertrand Richard De Latour2
1Department of Thoracic and Vascular Surgery, Yves Le Foll Hospital, Saint Brieuc, 22000, France.
Objectives:
To compare perioperative outcomes of complex basilar sublobar resection (CBSLR) versus lower lobectomy, both performed via a standardized subxiphoid thoracoscopic approach, and to assess the impact of advanced image guidance on pathological quality metrics.
Methods:
In a single-centre retrospective analysis (January 2016 to January 2024) of prospectively collected data, 98 consecutive patients underwent multiportal subxiphoid thoracoscopic anatomic resection for lower lobe lesions. Outcomes were compared between CBSLR and lower lobectomy. In non-small-cell lung cancer (NSCLC) patients undergoing CBSLR, pathological margins were analysed according to the use of advanced image guidance, associating 3D dynamic simulation (3D-DS) and fluorescence imaging.
Results:
Among 98 patients (NSCLC: n = 80; metastasis: n = 14; benign: n = 4), lower lobectomy was performed in 59 (60%) and CBSLR in 39 (40%), of whom 23 received advanced image guidance. Perioperative outcomes were comparable between CBSLR and lower lobectomy, including conversion to thoracotomy (3% vs 9%), overall complications (13% vs 15%), prolonged air leak (5% vs 2%), median length of stay (1 [IQR 1-2] vs 1 [IQR 1-3] days), readmission (5% vs 9%), and 30-day mortality (0% vs 1.7%) (all P > .05). In NSCLC patients, advanced image guidance significantly increased pathological margins (median 23 [19-35] mm vs 10 [10-20] mm, P = .013).
Conclusions:
Subxiphoid thoracoscopic CBSLR achieves perioperative outcomes equivalent to lower lobectomy while preserving lung parenchyma. The 3D-DS-assisted "butterfly" approach enhances oncologic margin clearance in challenging basilar resections and represents a promising strategy for lung-sparing anatomic surgery in complex lower lobe lesions.
