Robotic Left Upper Lobectomy

Interest and access to robot thoracic surgery has increased over the last decade. This increased interest from surgeons, hospitals, and patients has led many surgeons to transition from their standard practice of open or thoracoscopic lobectomy to robotic lobectomy. High-volume robotic programs have shown a decrease in the length of hospital stay, 30-day mortality, and postoperative transfusion requirements when lung resection is performed with the robotic technique compared to video-assisted thoracoscopic surgery and thoracotomy (1).

This video demonstrates a robotic left upper lobectomy. The patient was a 73-year-old woman who was found to have a 12 mm left upper lobe nodule on a screening computed tomography scan. Positron emission tomography demonstrated mild hypermetabolic activity. She was asymptomatic, and she was able to walk one mile and climb two flights of stairs. Her medical history included hypertension and chronic obstructive pulmonary disease, and she had a 10 pack-year history of smoking. The results of her pulmonary function tests were adequate.

She was taken for a left upper lobe wedge resection, and the frozen section confirmed adenocarcinoma. She then had a completion robotic lobectomy with mediastinal lymph node dissection of stations 5, 6, 7, and L9. At the completion of the procedure, an intercostal nerve block was performed and a 28 Fr chest tube was placed. The chest tube was subsequently removed, and the patient was sent home on postoperative day two. The final pathology revealed a 1.2 cm moderately differentiated adenocarcinoma, with zero out of eight lymph nodes positive for malignancy, stage T1aN0M0 IA. The robotic technique provides excellent exposure and visualization, and it allows for a complete oncologic resection. 

Reference

1. Farivar AS, Cerfolio RJ, Vallieres E, et al. Comparing robotic lung resection with thoracotomy and video-assisted thoracoscopic surgery cases entered into the Society of Thoracic Surgeons Database. Innovations. 2014;9(1):10-15.