Fissureless Approach to Robotic Left Upper Lobectomy: Aiming for Postoperative Day One Discharge

Dathe Benissan-Messan, MD

Product Details
Product ID: ACS-6016
Year Produced: 2020
Length: 9 min.


Introduction: Robotic lobectomy typically requires dissection in the fissure. This can be challenging in the presence of incomplete fissures, associated with an increased incidence of air leaks and prolonged hospitalizations. Methods: We describe a fissureless technique for a robotic left upper lobectomy. A completely hilar dissection is performed for division of the superior vein, upper lobe bronchus and pulmonary artery branches. All interlobar lymph nodes are removed. The fissure is divided last with serial applications of the robotic stapler. Results: The procedure was performed for a patient with a large biopsy proven non-small cell lung cell cancer in the left upper lobe, clinically staged T3N0. Total operative time was 235 minutes, and blood loss was minimal. The post-operative course was uncomplicated. There was no air leak and minimal pleural drainage, which allowed for chest tube removal and discharge to home on postoperative day #1. Final pathology revealed a 5.8cm squamous cell cancer resected with negative margins and 27 (15 N1; 12 N2) negative lymph nodes. Conclusion: Robotic left upper lobectomy may be performed with completely hilar dissection, yielding good N1 lymph node dissection, while avoiding opening the fissure. This technique may be useful to avoid air leaks in patients with incomplete fissures and facilitate early hospital discharge.