Robotic Left Upper Lobe Apicoposterior (S1 + S2) Segmentectomy: A Case Report and Discussion

The authors present the case of a 79-year-old man with a distant history of smoking who presented with a slowly enlarging 1 cm nodule. This was initially found on surveillance for a thoracic aortic aneurysm two years prior to resection and the authors were following it with repeat scans. On positron emission tomography (PET) scan, there was no metabolic activity in either the nodule or in the mediastinum. As monitoring continued, it began to grow to 1.5 cm and he was becoming short of breath. The authors then decided to do a computed tomography (CT) guided biopsy of the nodule, and it was found to be adenocarcinoma in situ. The CT scan demonstrated this to be an isolated lesion located between the apical and posterior segments of the left upper lobe. They decided to perform a segmentectomy due to its slow growing nature and his borderline lung function. His final pathology showed a 1.7 cm lepidic predominant adenocarcinoma 5 cm from closest margin, and no nodes were positive, for a final path of pT1bN0.  The knowledge and the skills to perform a pulmonary segmentectomy enable lung preservation in high-risk patients. The robot allows meticulous, reproducible intraparenchymal dissection, which may lead to decreased air leak and shorter length of stay.