Mastering Robotic Lung Resection: The French Lobectomy Technique for Standardized Surgical Education

The French lobectomy is a standardized robotic technique designed to improve reproducibility and enhance educational value in thoracic surgical training. Based on five anatomical exposure and dissection zones, the technique structures the procedure in a systematic and teachable format. An objective structured assessment scale has also been developed to accompany the technique, allowing for step-by-step evaluation of trainee performance. This approach is applicable to all lobectomies and segmentectomies and serves as a foundation for developing proficiency in robotic thoracic surgery. 

This video presents the case of a 76-year-old female patient with a progressive pulmonary lesion located in the left lower lobe, specifically within the basal pyramid. Due to a high suspicion of malignancy, surgical resection was indicated. 

At the author's institution, 3D reconstruction and mixed reality technology are routinely utilized for preoperative planning. These tools allow for enhanced visualization of patient-specific anatomy and enable virtual rehearsal of the surgical procedure, improving intraoperative precision and safety. 

The operation began with dissection of Zone 1, involving division of the inferior pulmonary ligament and exposure of lymph node station 9. Zone 2 was accessed via anterior traction of the lung, allowing for dissection of the inferior pulmonary vein and subcarinal lymph nodes (station 7). In Zone 3, inferior lung traction exposed the superior pulmonary artery and station 5/6 lymph nodes. Zone 4, related to the anterior hilum/superior pulmonary vein, was not dissected in this case, as the resection was limited to the basal pyramid. In Zone 5, the fissure was dissected using the colibri maneuver, followed by isolation and division of the arterial, venous, and bronchial structures of the basal pyramid. All vascular structures were safely stapled, and lymphadenectomy of station 11 and hilar nodes was performed. 

The immediate postoperative chest X-ray confirmed good lung re-expansion. Final pathology revealed a malignant lesion with negative margins. 

This case illustrates the practical application of the French lobectomy technique in a left basal segmentectomy and demonstrates how structured robotic approaches—supported by 3D and mixed reality planning—can enhance surgical safety, precision, and teaching potential in thoracic oncology. 

References

1. Mordojovich G, Hugen N, Bottet B, Montagne F, Bouabdallah I, Pagès PB, Sarsam M, Thomas PA, Baste JM. New standardized fivezone lobectomy with structured assessment in robotic surgery: the French lobectomy. J Thorac Dis. 2025 Apr 30;17(4):27182729. doi:10.21037/jtd241755.
2. Terra RM, Leite PHC, Dela Vega AJM. Global status of the robotic thoracic surgery. J Thorac Dis 2021;13:6123-8.
3. Andersson SE, Ilonen IK, Pälli OH, et al. Learning curve in robotic-assisted lobectomy for non-small cell lung cancer is not steep after experience in video-assisted lobectomy; single-surgeon experience using cumulative sum analysis. Cancer Treat Res Commun 2021;27:100362
4. Lefetz O, Baste JM, Hamel JF, et al. Robotic surgery and work-related stress: A systematic review. Appl Ergon 2024;117:104188.
5. Cerfolio RJ, Cichos KH, Wei B, et al. Robotic lobectomy can be taught while maintaining quality patient outcomes. J Thorac Cardiovasc Surg 2016;152:991-7.

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