Robotic Approach as the Gold Standard for Immunotherapy Lung Resections

The neoadjuvant chemoimmunotherapy pathway has become the standard of care for patients with resectable, locally advanced non-small cell lung cancer without actionable mutations. Its increasing use has introduced novel technical challenges, as fibrotic changes, inflammatory reactions, and altered tissue planes can complicate hilar dissection and vascular management, requiring careful surgical planning and flexible intraoperative strategies.

This video presents a robotic lobectomy performed after four cycles of platinum-based chemotherapy and pembrolizumab immunotherapy for non-small cell lung cancer. It focuses on the key technical steps, surgical decision-making, and the potential advantages of the robotic platform in a challenging post-treatment setting. Enhanced visualization, wristed instrumentation, and improved dexterity may facilitate precise dissection and vascular management while supporting the performance of minimally invasive surgery in complex operative conditions.

Finally, the complexity of the procedure is contextualized through the application of a previously developed multifactorial score designed to assess the complexity of lung resections after neoadjuvant therapy. This tool provides a structured assessment of operative difficulty and may contribute to a more consistent interpretation of the surgical challenges encountered in this case, supporting preoperative planning and intraoperative decision-making.

References

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