Four arm robotic double right segmentectomies S3 & S7–10 with fluorescence lung mapping

摘要

: Segmentectomy is an increasing topic in the era of telemanipulation surgery as these advanced procedures require hand-wrist skills and visual control to be properly done. This procedure can be more challenging than lobectomy as it requires more hilum dissection and an accurate intersegmental plan definition. Despite the development of techniques and tools in the past decade, there is no change yet in gold standard for lung carcinoma resection. Nevertheless, tumor size less than 2 cm, N0 status and lung sparing needs are accepted conditions to perform segmentectomy rather than lobectomy. We present here a case of a 66-year-old woman who was diagnosed with two suspected metachronous lung carcinomas cT1N0M0 of right S3 and right basal pyramid revealed by hemoptysis. In this situation, the double segmentectomy was considered as the best strategy to avoid a right pneumonectomy for multiple stage 1 carcinomas. We describe and discuss the technical steps of the procedure using a four-arm completely portal approach with a Xi system (Intuitive SurgicalR, California) and the use of near-infrared fluorescence with indocyanine green intravenous injection for inter-segmental plan definition. In the step-by-step video we emphasize on the bimanual sewing and knotting technique to ensure a controlled and safe dissection as to reproduce an open surgery technique in a closed chest.