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My Favorite Segmentectomy. Robotic S2+S6 Bisegmentectomy for an Interfissural Right Sided Tumor
I was very nervous about taking on this case because normally when you do a segment 6 or segment 2 resection, the first move is to go in the fissure to then easily dissect out all the anatomy. With the tumor in the fissure, that was not going to be possible. I knew that I would have to find the artery, bronchus, and vein to the apical segment of the right lower lobe all from posteriorly to be able to successfully transect them and then allow the segmental fissure to be opened up which would allow access to S2 (the posterior segment of the right upper lobe).
Thankfully, with the great vision of the Intuitive Xi, careful dissection and removal of all lymph nodes, and with 3D reconstruction performed by Ben Waterhouse, using the Horos software as taught to us by Brian Mitzman's videos, we were able to perform this segmentectomy very nicely!
Certainly my take away learning points include:
- Take away all lymph nodes and do as much lymphadenectomy as possible first.
- Dissect distally into all vessels to identify the anatomy and the other segmental structures.
- Use bronchial inflation and ICG to further assist identification of the intersegmental planes.
- Get a really nice 3D reconstruction CT scan as your roadmap.
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