Standardized Five Steps for Robotic Left Upper Lobectomy Using Robotic Stapler

This video demonstrates the standardized five steps for robotic left upper lobectomy with a robotic stapler. The surgery was performed for a 64-year-old man with a history of smoking and COPD, in whom the authors discovered a centrolobar nodule in the left upper lobe which fixed on a TEP Scanner. In this video, the authors report the different trocard emplacements, the robot installation, and the different standardized steps for left upper lobe resection. 

The dissection was performed counter-clockwise starting from the pulmonary ligament (zone 1). In this step, the same exposition was maintained for the lymphadenectomy of lymph nodes on station 9. The zone 2 (posterior hilum) consisted of exposing the posterior hilum zone, giving a good access for a better dissection for the posterior side of the left vein and mediastinal artery. The same exposition was used to perform the lymph node dissection for stations 7 and 10. Then, the third zone was the upper hilum side that gives access to the superior side of the mediastinal artery, and also the stations 10, 5, and 6 for lymphadenectomy. The lung was then retracted to the posterior pleural side to get access to the zone 4 or the anterior hilum. In that step, a dissection for the mediastinal artery and the different lymph nodes in stations 10 and 11 were performed. After making the whole tour of the hilum, the final step consisted of fissure time. In this step, a complete lymph node dissection for lymph nodes in station 11 and 12 were performed, as artery, vein, and bronchus control before section with a robotic stapler. Every step is summarized with the main surgical time and operating mean duration. The video is useful for learning and standardizing every robotic left upper lobectomy.

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