Post-Induction Robotic Left Lower Lobectomy in a Patient With a Previous S9–S10 Left Segmentectomy

The clinical case presented in this video concerns a 67-year-old female patient who came to the authors’ attention in 2021 after undergoing a computed tomography (CT) scan that revealed the incidental finding of a 16 mm ground-glass opacity (GGO) located in the left lower lobe. As the lesion was well localized and adequate surgical margins could be achieved, an S9–S10 segmentectomy was considered feasible, and the multidisciplinary team decided to proceed with surgery.

The operation was successful, and the histological report showed no unfavorable histoprognostic factors. The patient was subsequently referred for follow-up.

However, in 2025, a follow-up CT scan revealed the presence of a mass in the left lower lobe, likely representing tumor recurrence. Fine-needle aspiration confirmed the presence of a neoplasie, specifically a PD-L1 positive lung adenocarcinoma. The patient was therefore treated with chemo-immunotherapy, achieving a good response.

At this point, the surgical challenge began. The patient was considered a candidate for a left lower lobectomy, but the procedure was particularly demanding due to several factors, including the presence of emphysematous lung parenchyma related to her history as a heavy smoker, as well as fibrosis and necrosis resulting from the previous surgery and prior chemo-immunotherapy. For these reasons, the operation could be considered especially challenging to perform using a robotic approach.

The aim of this video is to demonstrate that, with careful preoperative planning and appropriate surgical technique—particularly emphasizing prevention and intraoperative control—even a highly complex procedure such as this can be safely performed using a robotic approach.

This video submission is from the 2026 CTSNet Instructional Video Competition. Stay tuned to CTSNet.org and the CTSNet YouTube channel in the coming weeks to watch all entries from the competition, including the winning videos.  

References

1. Riely GJ, Wood DE, Aisner DL, Loo BW Jr, Axtell AL, Bauman JR, Bharat A, Chang JY, Desai A, Dilling TJ, Dowell J, Durm GA, Gettinger S, Grotz TE, Gubens MA, Juloori A, Lackner RP, Lanuti M, Levy B, Lin J, Lovly CM, Maldonado F, Morgensztern D, Mullikin TC, Ng T, Owen D, Owen DH, Patel SP, Patil T, Polanco PM, Riess J, Mendez ALR, Shapiro TA, Singh AP, Stevenson J, Tam A, Tanvetyanon T, Yanagawa J, Yau E, Gregory K, Hang L. NCCN Guidelines® Insights: Non-Small Cell Lung Cancer, Version 7.2025. J Natl Compr Canc Netw. 2025 Sep;23(9):354-362. doi: 10.6004/jnccn.2025.0043. PMID: 40930154.
2. Li HJ, Ding JY, Nie Q, Hong HZ, Qiu ZB, Fu R, Zhang C, Zhang JT, Xu ZY, Yang J, Zhang S, Lin JT, Yang XN, Jiang BY, Zhong WZ. Advantages of robotic-assisted thoracic surgery after neoadjuvant therapy in NSCLC: A propensity score-matched analysis. Eur J Surg Oncol. 2025 Aug;51(8):110022. doi: 10.1016/j.ejso.2025.110022. Epub 2025 Apr 7. PMID: 40250266.

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