Robotic surgical techniques for standard segmentectomies

Abstract

Growing evidence suggests that segmentectomy is a safe and oncologically equivalent alternative to lobectomy for early stage non-small cell lung cancer (NSCLC) patients with tumors ≤2 cm. Robotic-assisted surgery is a particularly adaptable platform for performing segmentectomies given the excellent visualization and wristed instrumentation it provides. Additionally, retrospective studies have reported that robotic segmentectomies have perioperative and oncologic outcomes comparable to video-assisted thoracoscopic surgery (VATS), further garnering interest in this approach. Standard segmentectomies include the superior segmentectomy (S6), basilar segmentectomy (S7-10), left upper lobe trisegmentectomy (S1-3), and left upper lobe lingulectomy (S4-5). A comprehensive approach to performing robotic segmentectomy begins with patient evaluation and an assessment of high-resolution axial imaging to confirm early stage and resectability with appropriate margins. In this article, we discuss robotic surgical techniques related to patient positioning, port placement, and key operative steps for successful completion of standard segmentectomies.