Robotic Type C Extended Sleeve Lobectomy for Locally Advanced Lung Cancer

S. Uchida¹, K. Suzuki^2
1Department General Thoracic Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo ²Department of General Thoracic Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo

Please explain the educational or technical point that this video addresses.: Extended sleeve lobectomy for locally advanced lung cancer is strictly challenging procedure to avoid pneumonectomy. We report a case of robotic extended sleeve lobectomy without any perioperative complications. Robotic extended sleeve lobectomy is a substantial and less invasive surgical procedure for centrally located lung cancer in terms of feasible operative risk, curability, and preserving lung function.

Please provide a 250 word summary of the surgical video being submitted.: A 83-year-old man was pointed out a solid mass in the left lower lobe by computed tomography scan. This tumor had directly invaded the left lingular bronchus. Positron emission tomography scan revealed a high standard uptake value for the main tumor and hilum lymph node without distant metastases. The patient was clinically diagnosed with squamous cell lung carcinoma (cT2bN1M0, stage IIB), according to the 8th edition of the Lung Cancer Classification. A four-arm robotic approach using the da Vinci Xi system (Intuitive Surgical, Sunnyvale, CA, USA) was used for the surgery. After the left lingular segment and lower lobe were removed by robotic retrograde approach, bronchoplasty was performed between the left main and upper division bronchus, so called type C extended sleeve lobectomy. Frozen sections of proximal and distal bronchial margins were negative. Anastomosis was performed with continuous running sutures and full-thickness bites using 3-0 double ended needle monofilament non-absorbable material which was made extrathoracically by ourselves. No tissue covered the anastomosis. The operative time was 227 minutes with a blood loss of 5 mL. The surgeon console time was 200 minutes. The postoperative course was good and uneventful without anastomotic trouble. The result of his lung function tests at 3 months after the operation was compared with the preoperative values. Regarding lung function, first-second forced expiratory volume decreased from 2.19 L before the operation to 1.93 L after the operation, showing that functional loss of the lung was minimal.