Título

ROBOTIC RIGHT APICOPOSTERIOR S1 AND S2 ANATOMIC SEGMENTECTOMY

Objetivo

Much is being discussed about how far surgeons need to go with lung resection among ground glass opacities (GGO) and part-solid lesions. However, one thing that is becoming well accepted is the improved quality of anatomical lung resections with new technological perspectives. 

Resumo do vídeo

This video presents a case of a forty-five-year-old woman, nonsmoker, with no medical records. She underwent a CT scan because of COVID-19 suspicions and ground-glass opacity on the right upper lobe measuring 15 mm was found, without any other relevant finding. It was decided to a follow-up in six months, which showed an increase in size to 20 mm with a small excavated area and consolidation tumor ratio (CTR) < 0.5. Therefore, regarding the high probability of primary lung adenocarcinoma, and after discussing the possibilities with the patient, the medical team opted to perform an upfront surgery. PET scan and brain MRI showed no distant metastasis and no lymph node uptake. 
Given the localization of the lesion on the transition to S1 and S2, to guarantee oncology margin the surgeons performed a robotic-assisted thoracoscopic (RATS) right S1 + S2 apicoposterior segmentectomy using a Da Vinci Xi® surgical platform.
The procedure was uneventful, and the patient was discharged on the second postoperative day.
The final anatomopathological result confirmed primary lung adenocarcinoma with lepidic and acinar patterns. The parenchymal and bronchial margins distance was 2.9cm and 3.5cm respectively. Final staging pT1c pN0
A huge increase of the robotic surgeries is well known, and with them the number of anatomic segmentectomies under an increment of 100% to 200% on the first few years after robotic implemental on some institutions . The endowrist and more democratic learning curve of the platforms, provide feasible and safe alternative for difficult procedures, including a big raise of complex segmentectomies, allowing more surgeons to ensure oncological purposes safely .