Uniportal Pure Robotic Lingulectomy

Uniportal robotic surgery is a relatively new technique that is being practiced in a few centers across the world. It offers the benefit of robotic surgery in a single incision.

The term pure uniportal robotic assisted thoracic surgery (U-RATS) is used when robotic thoracic surgery is performed through a single intercostal incision and without rib spreading using the robotic camera, robotic dissecting instruments, and robotic staplers.

This video presents the case of a seventy-one-year-old man who was diagnosed with coronary artery disease and had coronary stents in situ the time of the surgery. As a part of routine cardiac screening, he underwent a CT coronary angiogram and was diagnosed with a mass lesion in the lingula. A PET scan was then performed, which showed a localized lesion. It was decided to go ahead with a uniportal robotic assisted lingulectomy.

Arms one, two, and three were used in the procedure. A camera was used in arm three and kept at the posterior part of the incision. Arms one and two were used as the left and right hands respectively. 

Surgeons used a long curved dissector in the right hand and fenestrated bipolar in the left hand. A lingulectomy was done in the usual fashion. First, the lingular branch of the pulmonary artery was identified and stapled with a 45 mm curved tip robotic stapler. Then, the lingular branches of the superior pulmonary vein were stapled using a white reload. Finally, the lingular division of the left upper lobe bronchus was divided with a black 45 mm reload.

Indocyanine green was then used to demarcate the intersegmental plane. A 32 Fr chest drain was kept at the posterior part of the incision, and the wound was closed in the usual fashion. The chest drain was then removed on postoperative day three, and the patient was discharged.

References

1. Rivas DG, Bosinceanu M, Dunning J. Uniportal Robotic Surgery: A Step-by-Step Guide to Setup by Diego Gonzalez Rivas. September 2022. doi:10.25373/ctsnet.21092140.v1

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