Robotic-Assisted Thoracoscopic Left-Sided Apicoposterior (S1+S2) Segmental Resection

Wissam Raad, MD, FACS, FRCS

Product Details
Product ID: ACS-6015
Year Produced: 2020
Length: 7 min.


Objective: Anatomic segmentectomy is one of the preferred modes of resection for patients with early stage lung cancer who cannot tolerate a lobectomy. Due to the variable number of arterial branches, an apicoposterior segmentectomy is technically challenging especially when a minimally invasive approach is utilized. The purpose of this video is to describe our technique of robotic-assisted resection for the inferomedial segment of the left lower lobe. Methods: The patient is placed in the right lateral decubitus position. We utilize a 4-arm-4-incision approach with the ports placed in the eighth intercostal space. A multilevel intercostal block and a systematic lymph node sampling is first performed. The inferior pulmonary ligament is then divided. Individual ligation of the segmental artery, bronchus, and vein in this sequence is then performed. Intravenous Indocyanine Green is injected to identify the margins of the apicoposterior segments S1+S2. Robotic staples are then used to complete the segmentectomy. Results: Patients are out of bed on the evening of the procedure. The chest tube is removed on postoperative day number one and the patients are usually discharged home on the first postoperative day. Conclusions: Segmentectomy is a reasonable oncologic resection for patients who do not tolerate a lobectomy. Our minimally invasive robotic-assisted approach for left inferomedial segmentectomy is safe and reproducible.