Robotic Left Lower Lobe Split Lateral (S9) and Posterior (S10) Basal Bisegmentectomy

The authors present the case of a 63-year-old patient with an 11 mm nodule in the posterobasal segment (S10) of the left lower lobe. This grew from an initial size of 8 mm over a 12-month period. Image-guided biopsy was rejected, and after a multidisciplinary meeting discussion and with further discussion with the patient, a segmentectomy for diagnosis and potential treatment was planned. The tumor location and the lung anatomy on the CT scan were carefully reviewed and a combined S9+S10 bisegmentectomy was planned.

This video describes the technique used to perform a robotic-assisted left lower lobe posterolateral basal bisegmentectomy. After dividing the relevant hilar structures and in particular, the bisegment’s shared arterial trunk (devascularizing the targeted bisegments), intravenous indocyanine green (ICG) was injected and the intersegmental planes were accurately identified by fluorescence imaging using the ‘Firefly’ mode of the da Vinci endoscope. The intersegmental plane was marked using diathermy and was later divided using Da Vinci’s EndoWrist staplers. This operation effectively split the left lower lobe, leaving segments S6 and S8 detached from one another after removing the S9+S10 bisegment.

References

1. Suzuki K, Saji H, Aokage K, Watanabe S, Okada M, Mizusawa J, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg. 2019;158(3):895-907.
2. Nomori H, Mori T, Ikeda K, Yoshimoto K, Iyama K, Suzuki M. Segmentectomy for selected cT1N0M0 non-small cell lung cancer: a prospective study at a single institute. J Thorac Cardiovasc Surg. 2012;144(1):87-93.
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