Robotic Right Lower Lobe Anteromedial Basilar (S7 + S8) Segmentectomy: A Case Report and Discussion

Pulmonary segmentectomy can be an adequate oncological lung resection for early stage lung cancer and deeper metastatic lesions. In select patients, the outcomes are comparable to lobectomy. Historically, this operation has been associated with higher air leak and prolonged length of stay (1). Both video-assisted (VATS) and robotic assisted segmentectomy have similar outcomes (2). The authors believe the robotic approach allows for a more precise dissection secondary to its 3D visibility, dexterity, and wrist mobility. This in turn leads to less air leak and less conversion to lobectomy. This is especially evident in patients with emphysema and obesity. The authors provide a video and description of a patient with a nodule isolated to S7+S8 of the right lower lobe.

The authors present a case of a 60-year-old woman with history of advanced colorectal cancer requiring cytoreduction surgery and HIPEC over five years ago. She was recently found to have an isolated PET avid lesion in the anteromedial segments of the right lower lobe. The authors decided to do a pulmonary segmentectomy using the da Vinci Xi robotic platform. They describe port placement, technical considerations, and anatomical specifics when approaching this particular segment.

In the era of increasing lung cancer screening in patients, a majority of lung tumors are being found at early stages. Pulmonary segmentectomy can offer a lung-preserving, oncological resection option in the appropriate setting. Both VATS and robotic approaches are considered comparable in many aspects. However, the robotic approach has been associated with decreased incidence of conversion to thoracotomy or lobectomy, and some studies have suggested that it leads to less air leak and shorter hospital length of stay (3). This was evident with next day discharge of this patient and consistent with a median length of stay of two days in the authors’ 100 consecutive segmentectomies.

References

1. Jensik RJ, Faber LP, Kittle CF. Segmental resection for bronchogenic carcinoma. Ann Thorac Surg. 1979;28:475–483.
2. Miller DL, Rowland CM, Deschamps C, Allen MS, Trastek VF, Pairolero PC. Surgical treatment of non-small cell lung cancer 1 cm or less in diameter. Ann Thorac Surg. 2002;73: 1545–1551.
3. Orsini B, Baste JM , Gossot D, Berthet JP , Assouad J, Dahan M, et al. Index of prolonged air leak score validation in case of video-assisted thoracoscopic surgery anatomical lung resection: results of a nationwide study based on the French national thoracic database, EPITHOR. Eur J Cardiothorac Surg. 2015 Oct;48(4):608-611. Epub 2015 Jan 5.

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