Robotic Right Anteromedial Basilar Bisegmentectomy

B. Wei¹, I. Lapis^2
1University of Alabama at Birmingham, Birmingham, Alabama ²Harvard School of Public Health, Cambridge, Massachusetts

Please explain the educational or technical point that this video addresses.: Basilar bisegmentectomy is an uncommonly described operation, but permits preservation of a significant amount of parenchyma compared to a lower lobectomy. This video abstract demonstrates a technique for robotic resection of the right anterior and medial basilar segments for lung cancer.

Please provide a 250 word summary of the surgical video being submitted.: The patient was a 74-year-old woman with an enlarging 1.5 cm mildly FDG avid (SUV max 5.7) right lower lobe adenocarcinoma. PET-CT scan did not show any evidence of lymphadenopathy or distant disease. She was a former smoker with a DLCO of 55% and FEV1 82% of predicted. She reported dyspnea with 1 block of walking. Her ECOG status was 1. Given her degree of dyspnea, segmentectomy was preferred over lobectomy. Based on the CT scan, we planned to resect the right anterior basilar segment and possibly the medial basilar segment. A completely portal technique using four robotic arms was utilized, with two 8 mm robotic ports (camera, paraspinal accessory arm), two 12 mm robotic ports (right and left working arms), and a 12 mm assistant port.

The hilar structures going to the right anterior basilar segment were divided. Due to the proximity of the margin, however, the decision was made to proceed with resection of both the anterior and medial segments. The structures going to the medial basilar segment were then divided, and the basilar bisegment was transected from the remainder of the right lower lobe. Operative time was 160 minutes; console time was 117 minutes. Her chest tube was removed and she was discharged home on postoperative day 2. Pathology demonstrated a well-differentiated, solid and acinar 1.4 cm T1bN0 stage IA2 adenocarcinoma. Spread through air spaces was seen. Eleven lymph nodes from four mediastinal stations (2R, 4R, 7, 8) and two hilar stations (levels 10, 11) were dissected.