Single-port robotic right upper lobe lobectomy: A case report

Abstract

Central MessageWe present a technique of single-port robotic lobectomy using the da Vinci SP system (Intuitive Surgical).See Commentary on page XXX. We present a technique of single-port robotic lobectomy using the da Vinci SP system (Intuitive Surgical). See Commentary on page XXX. Robotic lung resection has become increasingly accepted as a safe and effective alternative to thoracoscopic surgery.1Wu H. Jin R. Yang S. Park B.J. Li H. Long-term and short-term outcomes of robot-versus video-assisted anatomic lung resection in lung cancer: a systematic review and meta-analysis.Eur J Cardio Thorac Surg. 2021; 59: 732-740Crossref PubMed Scopus (0) Google Scholar The introduction of the da Vinci SP System (Intuitive Surgical) has recently marked a major technical breakthrough.2Wu C.F. Cheng C. Suen K.H. Stein H. Chao Y.K. A preclinical feasibility study of single-port robotic subcostal anatomical lung resection and subxiphoid thymectomy using the da Vinci SP System.Diagnostics. 2023; 13: 460Crossref Scopus (0) Google Scholar Here, we describe a patient diagnosed with a right upper lobe adenocarcinoma who underwent a successful robotic lung resection using the da Vinci SP System. A 70-year-old woman was referred to the surgical clinic due to a diagnosis of cT2 N0 M0 adenocarcinoma in the right upper lobe (RUL) (Figure E1). RUL lobectomy was performed on the da Vinci SP System. Informed consent was obtained for publication of the patient's data. The study was approved by the Institutional Review Board of Chang Gung Memorial Hospital, Taiwan (reference: CGMH-IRB 202101423A0; October 12, 2021. This study is registered at www.ClinicalTrials.gov, identifier NCT05535712). The surgical technique is illustrated in Video 1. After intubation with a double-lumen endotracheal tube, the patient was placed in the left lateral decubitus position. A 4-cm incision mark was initially positioned at the intersection between the subcostal arch and the midclavicular line (Figure E2, red line). A 5-mm observation port was subsequently created at a distance of 10 to 12 cm, perpendicular to the midpoint of the subcostal incision mark, and connected to a carbon dioxide insufflator (pressure, 8 mm Hg) (Figure E2, green circle). The subcutaneous tissue and the oblique muscles were incised until the transverse abdominis fascia was visible. By tunneling with finger blunt dissection below the costal cartilages and above the diaphragm, the pleural space was accessed. After insertion of a uniportal access device (da Vinci SP Access Port Kit) and connection to an insufflator, the single 2.5-cm trocar was docked to the da Vinci SP Patient-Side Cart Arm. In this procedure, four robotic instruments were employed: a Cadiere forceps, a fenestrated bipolar forceps, a Maryland bipolar forceps, and a monopolar curved scissors. The surgical sequence mirrored that of multiport robotic surgery. Following the completion of mediastinal lymph node dissection (Figure 1), a meticulous dissection was carried out alongside the vessels, creating adequate space for the secure introduction of the stapler. The handheld endovascular stapling instrument was subsequently inserted (Figure 2).Figure 2The transection of the right upper lobe pulmonary artery was executed using a handheld endovascular stapling instrument, which was inserted through the subcostal incision. Both external and internal views are displayed.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Upon completion of the procedure, the diaphragm and the rest of the wound were closed. The total operating time was 210 minutes, including the creation of subcostal access (14 minutes) and robot docking (4 minutes). No significant intraoperative events were observed. The chest tube was removed on postoperative day 1 and the patient was discharged home on postoperative day 3 without complications. The immediate postoperative pain intensity score was measured at 5 out of 10; however, on the first postoperative day, it