Single Incision, Single Port Robotic Right Upper Lobectomy

This video is part of CTSNet’s 2025 Resident Video Competition. Watch all entries into the competition, including the winning videos.  

In this video, the authors present a case of a single-incision, single-port robotic right upper lobectomy. The patient was a 62-year-old female with a history of hypertension, diabetes, and prior tobacco use. She had an incidentally discovered right upper lobe nodule that was diagnosed as squamous cell carcinoma. She underwent appropriate pulmonary function tests (PFTs) and demonstrated excellent functional status. 

The right pleural space was entered through a 4.5 cm subcostal incision centered at the eighth intercostal space. The lung was retracted cephalad, the inferior pulmonary ligament was divided, and a level 9 lymph node was removed. The lung was then retracted anteriorly, and further dissection was carried superiorly along the hilum up to the subcarinal space, where a level 7 lymph node was removed. 

The lung was then retracted posteriorly to proceed with dissection of the paratracheal lymph node space, as well as to expose the anterior hilum for future dissection. The paratracheal space was explored, and a level 4R lymph node was sent for permanent pathology. The anterior pleural reflection was opened over the superior pulmonary vein, with care taken to identify a separate middle lobe branch. Additional adhesions superior to the superior pulmonary vein were divided to allow for safe passage of the stapler.  

After dissecting out entry and exit sites, the superior pulmonary vein was encircled. A vessel loop was passed around the superior pulmonary vein to facilitate the safe passage of the stapler. One of the robotic arms was removed to make room for an endo-GIA stapler to be inserted through the assistant port. The procedure only utilized the subcostal incision without any accessory incisions. Once the stapler was inserted, the adjust mode was used to align the stapler, and camera mode was used to visualize the safe passage of the stapler. The superior vein was clamped and divided, exposing 
the underlying pulmonary artery.  

Dissection was carried out between the truncus anterior and the ongoing main pulmonary artery. Once the truncus anterior was encircled, a vessel loop was passed to allow for safe passage of the stapler, and the vessel was divided with a vascular stapler. This exposed a small accessory branch, which was encircled and divided with a stapler. A lymph node between the main pulmonary artery (PA) and the right upper lobe bronchus was removed. Dissection around the right upper lobe bronchus was initiated. Part of the anterior fissure was taken to help with retraction of the lung, facilitating the dissection of the remaining structures. With these changes in retraction, the right upper lobe bronchus was encircled and divided with a stapler. The posterior ascending branch was then encircled and divided. The lung was returned to the anatomic position, and the fissure was completed with several stapler fires. 

The patient tolerated the procedure well. Her chest tube was removed, and she was discharged home on postoperative day one. She was seen in follow-up clinic and was noted to be doing well with no complications. She did not use any narcotics after discharge. 

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.