Application of robot-assisted lung basal segmentectomy: A retrospective study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TAO Shaolin , DAI Fuqiang , MEI Longyong , FENG Yonggeng , FANG Chunshu , WU Licheng , SUN Tianyu , GUO Wei , DENG Bo ,  TAN Qunyou

Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, P. R. China;

Corresponding author：

TAN Qunyou, Email: tanqy001@163.com

Keywords：

Robot-assisted thoracic surgery; lung basal segmentectomy; surgery approaches

DOI：

10.7507/1007-4848.202207020

Video：

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Objective To summarize the experience of robot-assisted lung basal segmentectomy, and analyze the clinical application value of intersegmental tunneling and pulmonary ligament approach for S⁹ and/or S¹⁰ segmentectomy. Methods The clinical data of 78 patients who underwent robotic lung basal segmentectomy in our hospital between January 2020 to May 2022 were retrospectively reviewed. There were 32 males and 46 females with a median age of 50 (33-72) years. The patients who underwent S⁹ and/or S¹⁰ segmentectomy were divided into a single-direction group (pulmonary ligament approach, n=19) and a bi-direction group (intersegmental tunneling, n=19) according to different approaches, and the perioperative outcomes between the two groups were compared. Results All patients successfully completed the operation, without conversion to thoracotomy and lobectomy, serious complications, or perioperative death. The median operation time was 100 (40-185) min, the blood loss was 50 (10-210) mL, and the median number of dissected lymph nodes was 3 (1-14). There were 4 (5.1%) patients with postoperative air leakage, and 4 (5.1%) patients with hydropneumothorax. No patient showed localized atelectasis or lung congestion at 6 months after the operation. Further analysis showed that there was no significant difference in the operation time, blood loss, thoracic drainage time, complications or postoperative hospital stay between the single-direction and bi-direction groups (P>0.05). However, the number of dissected lymph nodes of the bi-direction group was more than that of the single-direction group [6 (1-13) vs. 5 (1-9), P=0.040]. Conclusion The robotic lung basal segmentectomy for pulmonary nodules is safe and effective. The perioperative results of robotic S⁹ and/or S¹⁰ complex segmentectomy using intersegmental tunneling and pulmonary ligament approach are similar.

Citation： TAO Shaolin, DAI Fuqiang, MEI Longyong, FENG Yonggeng, FANG Chunshu, WU Licheng, SUN Tianyu, GUO Wei, DENG Bo, TAN Qunyou. Application of robot-assisted lung basal segmentectomy: A retrospective study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 65-70. doi: 10.7507/1007-4848.202207020 Copy

1.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
2.	Takamori S, Oizumi H, Suzuki J, et al. Thoracoscopic anatomical individual basilar segmentectomy. Eur J Cardiothorac Surg, 2022, 62(1): ezab509.
3.	Pardolesi A, Park B, Petrella F, et al. Robotic anatomic segmentectomy of the lung: Technical aspects and initial results. Ann Thorac Surg, 2012, 94(3): 929-934.
4.	Musgrove KA, Spear CR, Abbas K, et al. Robotic pulmonary segmentectomy. J Thorac Dis, 2021, 13(10): 6179-6186.
5.	陈昶, 朱余明, 姜格宁, 等. 肺段切除术和肺叶切除术治疗直径≤2 cm且术中冰冻证实微乳头和实性亚型阴性肺腺癌的多中心随机对照研究. 中国胸心血管外科临床杂志, 2021, 28(11): 1292-1298.
6.	Handa Y, Tsutani Y, Mimae T, et al. Complex segmentectomy for hypermetabolic clinical stage ⅠA non-small cell lung cancer. Ann Thorac Surg, 2022, 113(4): 1317-1324.
7.	Mangiameli G, Cioffi U, Testori A. Lung cancer treatment: From tradition to innovation. Front Oncol, 2022, 12: 858242.
8.	Kneuertz PJ, Abdel-Rasoul M, D'Souza DM, et al. Segmentectomy for clinical stageⅠnon-small cell lung cancer: National benchmarks for nodal staging and outcomes by operative approach. Cancer, 2022, 128(7): 1483-1492.
9.	Zhou N, Corsini EM, Antonoff MB, et al. Robotic surgery and anatomic segmentectomy: An analysis of trends, patient selection, and outcomes. Ann Thorac Surg, 2022, 113(3): 975-983.
10.	刘成武, 蒲强, 梅建东, 等. 单向式胸腔镜基底段切除术352例的单中心回顾性研究. 中国胸心血管外科临床杂志, 2022, 29(10): 1284-1289.
11.	高磊, 林济红, 余绍斌, 等. 3D重建技术在胸腔镜解剖性下肺后基底段切除术中的应用. 中国医师杂志, 2019, 21(11): 1605-1608.
12.	Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
13.	陶绍霖, 康珀铭, 谭群友, 等. 经前侧入路达芬奇机器人辅助肺段切除术的临床分析. 中国胸心血管外科临床杂志, 2020, 27(2): 178-182.
14.	Igai H, Kamiyoshihara M, Kawatani N, et al. Thoracoscopic lateral and posterior basal (S9+10) segmentectomy using intersegmental tunnelling. Eur J Cardiothorac Surg, 2017, 51(4): 790-791.
15.	Zhu Y, Pu Q, Liu C, et al. Trans-inferior-pulmonary-ligament single-direction thoracoscopic RS9 segmentectomy: Application of stem-branch method for tracking anatomy. Ann Surg Oncol, 2020, 27(8): 3092-3093.
16.	Matsuura N, Igai H, Kamiyoshihara M. Uniportal thoracoscopic lateral and posterior basal segmentectomy using intersegmental tunneling: Comparison with multiportal approach. Asian J Endosc Surg, 2022.
17.	Endoh M, Oizumi H, Kato H, et al. Posterior approach to thoracoscopic pulmonary segmentectomy of the dorsal basal segment: A single-institute retrospective review. J Thorac Cardiovasc Surg, 2017, 154(4): 1432-1439.
18.	Liu C, Liao H, Guo C, et al. Single-direction thoracoscopic basal segmentectomy. J Thorac Cardiovasc Surg, 2020, 160(6): 1586-1594.

1. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
2. Takamori S, Oizumi H, Suzuki J, et al. Thoracoscopic anatomical individual basilar segmentectomy. Eur J Cardiothorac Surg, 2022, 62(1): ezab509.
3. Pardolesi A, Park B, Petrella F, et al. Robotic anatomic segmentectomy of the lung: Technical aspects and initial results. Ann Thorac Surg, 2012, 94(3): 929-934.
4. Musgrove KA, Spear CR, Abbas K, et al. Robotic pulmonary segmentectomy. J Thorac Dis, 2021, 13(10): 6179-6186.
5. 陈昶, 朱余明, 姜格宁, 等. 肺段切除术和肺叶切除术治疗直径≤2 cm且术中冰冻证实微乳头和实性亚型阴性肺腺癌的多中心随机对照研究. 中国胸心血管外科临床杂志, 2021, 28(11): 1292-1298.
6. Handa Y, Tsutani Y, Mimae T, et al. Complex segmentectomy for hypermetabolic clinical stage ⅠA non-small cell lung cancer. Ann Thorac Surg, 2022, 113(4): 1317-1324.
7. Mangiameli G, Cioffi U, Testori A. Lung cancer treatment: From tradition to innovation. Front Oncol, 2022, 12: 858242.
8. Kneuertz PJ, Abdel-Rasoul M, D'Souza DM, et al. Segmentectomy for clinical stageⅠnon-small cell lung cancer: National benchmarks for nodal staging and outcomes by operative approach. Cancer, 2022, 128(7): 1483-1492.
9. Zhou N, Corsini EM, Antonoff MB, et al. Robotic surgery and anatomic segmentectomy: An analysis of trends, patient selection, and outcomes. Ann Thorac Surg, 2022, 113(3): 975-983.
10. 刘成武, 蒲强, 梅建东, 等. 单向式胸腔镜基底段切除术352例的单中心回顾性研究. 中国胸心血管外科临床杂志, 2022, 29(10): 1284-1289.
11. 高磊, 林济红, 余绍斌, 等. 3D重建技术在胸腔镜解剖性下肺后基底段切除术中的应用. 中国医师杂志, 2019, 21(11): 1605-1608.
12. Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
13. 陶绍霖, 康珀铭, 谭群友, 等. 经前侧入路达芬奇机器人辅助肺段切除术的临床分析. 中国胸心血管外科临床杂志, 2020, 27(2): 178-182.
14. Igai H, Kamiyoshihara M, Kawatani N, et al. Thoracoscopic lateral and posterior basal (S9+10) segmentectomy using intersegmental tunnelling. Eur J Cardiothorac Surg, 2017, 51(4): 790-791.
15. Zhu Y, Pu Q, Liu C, et al. Trans-inferior-pulmonary-ligament single-direction thoracoscopic RS9 segmentectomy: Application of stem-branch method for tracking anatomy. Ann Surg Oncol, 2020, 27(8): 3092-3093.
16. Matsuura N, Igai H, Kamiyoshihara M. Uniportal thoracoscopic lateral and posterior basal segmentectomy using intersegmental tunneling: Comparison with multiportal approach. Asian J Endosc Surg, 2022.
17. Endoh M, Oizumi H, Kato H, et al. Posterior approach to thoracoscopic pulmonary segmentectomy of the dorsal basal segment: A single-institute retrospective review. J Thorac Cardiovasc Surg, 2017, 154(4): 1432-1439.
18. Liu C, Liao H, Guo C, et al. Single-direction thoracoscopic basal segmentectomy. J Thorac Cardiovasc Surg, 2020, 160(6): 1586-1594.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of robot-assisted lung basal segmentectomy: A retrospective study

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