Case Report: Robotic Segmentectomy after Prior Lobectomy

Richard Zheng, MD; Courtney L. Devin, MD; Nathaniel R. Evans III, MD, FACS

Product Details
Product ID: ACS-5829
Year Produced: 2019
Length: 9 min.


We describe a case in which a robotic right superior segmentectomy performed after a previous right upper lobectomy. The patient is a 79 year old woman with an enlarging ground-glass opacity on surveillance imaging, which had grown from 6 to 9 millimeters over the course of a year with a newly developed solid component. PET scan confirms mild hypermetabolic activity at the site of this nodule. Her past medical history is significant for a stage I right upper lobe adenocarcinoma that was resected via a robotic-assisted right upper lobectomy several years prior. The patient was placed in left lateral decubitus and the pleural cavity was entered in the usual fashion for a robotic lobectomy. Meticulous dissection was performed through dense adhesions around hilar structures and towards the azygos vein. Lymph nodes were harvested from around the inferior pulmonary vein, and the superior segment pulmonary vein was isolated and circumferentially dissected. The major fissure was developed with a combination of cautery and blunt dissection. The robotic stapler was used to separate the lobes along the fissure. With the fissure developed, vascular control of the superior segmental vessels and bronchus was obtained and they were divided. Intraoperative near-red angiography with indocyanine green is used to identify the intersegmental plane and aid with division of the superior segmental parenchyma. Perfusion to the staple line was assessed with intraoperative fluoroscopy and appeared adequate. Postoperatively, the patient had an uncomplicated stay and was discharged on the first postoperative day.