Robotic right upper lobectomy: Twelve steps

摘要

Central MessageA posterior-to-anterior approach for a robotic right upper lobectomy is a safe and efficient method for resection.See Commentary on page 283. A posterior-to-anterior approach for a robotic right upper lobectomy is a safe and efficient method for resection. See Commentary on page 283. Feature Editor's Introduction—Welcome to the beginning of a series of new format articles in JTCVS Techniques termed Video Atlas Articles (VAAs). VAAs are peer-reviewed descriptions of a surgical procedure crystallized into a series of steps, with each step taught through its own narrated video and corresponding short text. The purpose of the VAA series is to provide continuing surgical education in an enduring format. Quality is maintained by the invitation of expert authors and by the iterative peer-review process involving expert reviewers. Thoracic surgeons are privileged to care for patients with a vast breadth and depth of conditions using an expansive armamentarium of rapidly evolving techniques. Most thoracic surgeons will perform operations they had never before performed in their training, and many will become expert in them. In fact, an entire generation of thoracic surgeons learned robotic thoracic surgery without residency or fellowship training on the robot, and surgeons from this generation are the current leaders in robotic thoracic surgery. This field is fast-paced and rapidly evolving. To provide the highest level of care to our patients, to embrace (and drive) the exciting innovation in our field, and sometimes even to remain relevant in the field of thoracic surgery requires the surgeon's effort in self-learning. There are many modalities for continuing surgical education; however, with regard to technique, there is little substitute for the first-hand experience of observing an expert surgeon operating, for junior and seasoned surgeons alike. The VAA is designed to replicate this experience in a quality-assured, on-hand, and high- impact format. Robotic right upper lobectomy is an index operation of the modern thoracic surgeon, and herein it is professionally illustrated in a VAA. Bryan M. Burt, MD The right upper lobectomy is a standard minimally invasive surgical procedure. Here we describe our process for performing the right upper lobectomy using a posterior-to-anterior approach. Patient consent was attained for all the patient data and media used in this report. Our technique for robotic right upper lobectomy is described in 12 steps, each with an accompanying video. This described posterior-to-anterior approach uses the da Vinci Xi system (Intuitive Surgical, Sunnyvale, Calif). The robotic arm configuration, with associated instrumentation, is as follows:Robotic arm 1: tip-up fenestrated grasperRobotic arm 2: cadiere forcepsRobotic arm 3: 0-degree robotic cameraRobotic arm 4: long bipolar grasper (with energy) or robotic stapler Single lung isolation is achieved with a double-lumen endotracheal tube. The patient is placed in the left lateral decubitus position. Care is taken to adequately pad the patient's arms and legs, to buffer any zone against which the patient's body will be pressed.1Cerfolio R.J. Steenwyk B.L. Watson C. Sparrow J. Belopolsky V. Townsley M. et al.Decreasing the preincision time for pulmonary lobectomy: the process of lean and value stream mapping.Ann Thorac Surg. 2016; 101: 1110-1115Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar A mild degree of flexion is then introduced to the operating table to increase the space available between the ribs and to displace the hip from the chest. No arterial line or urinary catheter is placed for the procedure.2Geraci T.C. Sasankan P. Luria B. Cerfolio R.J. Intraoperative anesthetic and surgical concerns for robotic thoracic surgery.Thorac Surg Clin. 2020; 30: 293-304Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar The right upper lobectomy is performed in the following 12 steps:1.Port placement (Video 1). The sc