Robotic Right Lower Lobe Anterobasal (S8) Segmentectomy

A segmentectomy is indicated in selected patients with non-small-cell lung cancer with peripheral nodules measuring greater than 2 cm and a less than 50 percent ground-glass appearance on computed tomography (CT) (1).

This video features the case of an eighty-year-old asymptomatic man with a history of symptomatic epilepsy who underwent CT for an unrelated condition. He had a peripheral lung nodule measuring 1.5 cm in the right S8 segment, and it had a 50 percent ground-glass appearance. Positron emission tomography-CT revealed that the maximum standardized uptake value of the nodule was 2.2, and this was without fluorodeoxyglucose uptake at any other site. The patient underwent a robotic right lower lobe anterobasal segmentectomy.

The chest tube was removed on postoperative day two, and the patient was discharged uneventfully. Histopathological examination showed adenocarcinoma stage pT1aN0M0.

The authors wish to highlight the following recommendations:

1. Careful and detailed preoperative CT evaluation is essential to confirm the anatomical structures and their orientation in a patient.
2. Adequate dissection of the pulmonary artery should be performed to accurately determine the anatomy of the relevant structures.
3. Bronchoscopic evaluation is helpful to accurately identify the target bronchus.
4. Indocyanine green fluorescence imaging is an easy and effective method to identify the segmental boundary.
5. If possible, the peripheral bronchial stump should be pulled toward the site of resection during parenchymal separation (lung segment resection) using a linear cutter stapler.

Reference

1. National Comprehensive Cancer Network. Non-Small-Cell Lung Cancer (Version 5. 2021). http://www.nccn.org/professionals/physician_gls/pdf/nsclc.pdf

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