Introduction. Rapid adoption of minimally invasive surgery into clinical practice has conveyed improvements in outcomes across many surgical specialties. Robotic surgery offers additional advantages due to imbedded safety technologies, improved dexterity and digital enhancement, allowing, complex nonstandard anatomic pulmonary resections. We present a case of robotic-assisted right middle lobectomy with en bloc antero-apical bisegmentectomy of the right upper lobe for the challenging location of the lung cancer.
Methods. A 76-years-old male presented biopsy proven 2.5 cm squamous cell carcinoma of the right upper lobe invading middle lobe across the minor fissure. Staging workup revealed a localized disease and after comprehensive preoperative evaluation the patient was deemed a surgical candidate and was brought for elective robotic resection.
Results. Intraoperatively a right upper lobe mass with extension across the minor fissure was confirmed. Decision was to proceed with middle lobectomy with en bloc antero-apical bisegmentectomy. Use of robotic technology has facilitates identification of the structures, dissection and conduct of this complex operation. Despite prolonged air leak patient has undergone uneventful recovery and was discharged on POD 14. Final pathologic stage was pT2aN0 / Stage 1B squamous cell carcinoma with focal sarcomatoid differentiation
Conclusions. In the video technique of robotic middle lobectomy with en bloc upper lobe bisegmentectomy is demonstrated. We hope this presentation will advance the knowledge among the practicing surgeons on technical nuances of complex pulmonary surgery.