Robotic thoracic surgery is a type of advanced minimally invasive lung surgery that allows the surgeon to control robotic instruments inserted through the patient’s thorax via ports that range between 8 – 12mm in diameter. The surgeon’s hand movements are mimicked by the robotic instruments inside the chest cavity, allowing delicate and complex manoeuvres to be performed accurately by appropriately trained surgeons. There is no rib-spreading and the surgeon’s vision is enhanced by 3D vision and 10x magnification. I hereby present a minimally invasive robotic segmentectomy for a suspected early-stage NSCLC, and a right upper lobe sleeve resection for a biopsy-proven carcinoid tumour, the first to be performed in Australia.
Anatomical segmentectomy requires the individual identification and division of segmental airways and vessels. Comparative outcomes of segmentectomy versus lobectomy for peripheral early-stage non-small cell lung cancer (NSCLC) in the landmark JCOG 0802 study demonstrated superior survival outcomes for patients who underwent segmentectomy. Interim analysis from the CALGB 140503 trial further demonstrated similar overall survival outcomes between the two treatment arms, suggesting that sublobar resections may be a feasible alternative to the traditionally accepted lobectomy for selected patients.
Sleeve lobectomy is a type of lung-sparing operation whereby a lobe is resected, followed by anastomosis of the proximal and distal airways to spare the distally located lung. A right upper lobe sleeve resection is performed by resection of the right upper lobe, followed by anastomosis of the right main bronchus and the bronchus intermedius that must be air-tight. This is a technically challenging operation that can potentially spare the right middle and lower lobes of the lung, avoiding a pneumonectomy. Successfully performed sleeve resections are associated with a significantly lower mortality and improved quality of life compared to the technically easier pneumonectomy procedure.