Robotic right upper lobectomy: Twelve steps

Abstract

Video clip is available online. Feature Editor's Introduction-Welcome to the beginning of a series of new format articles in JTCVS Techniques termed Video Atlas Articles (VAAs). VAAs are peerreviewed descriptions of a surgical procedure crystallized into a series of steps, with each step taught through its own narrated video and corresponding short text. The purpose of the VAA series is to provide continuing surgical education in an enduring format. Quality is maintained by the invitation of expert authors and by the iterative peer-review process involving expert reviewers. Thoracic surgeons are privileged to care for patients with a vast breadth and depth of conditions using an expansive armamentarium of rapidly evolving techniques. Most thoracic surgeons will perform operations they had never before performed in their training, and many will become expert in them. In fact, an entire generation of thoracic surgeons learned robotic thoracic surgery without residency or fellowship training on the robot, and surgeons from this generation are the current leaders in robotic thoracic surgery. This field is fastpaced and rapidly evolving. To provide the highest level of care to our patients, to embrace (and drive) the exciting innovation in our field, and sometimes even to remain relevant in the field of thoracic surgery requires the surgeon's effort in self-learning. There are many modalities for continuing surgical education; however, with regard to technique, there is little substitute for the first-hand experience of observing an expert surgeon operating, for junior and seasoned surgeons alike. The VAA is designed to replicate this experience in a quality-assured, on-hand, and high-impact format. Robotic right upper lobectomy is an index operation of the modern thoracic surgeon, and herein it is professionally illustrated in a VAA.

Self-assisting robot-assisted pulmonary lobectomy has favorable outcome compared to VATS lobectomy

“…This control provides a surgeon an opportunity to self-assist to complete the surgery. However, there is variability in robot-assisted lobectomy procedures in terms of using an assistant during the case (12)(13)(14). Some robot lobectomy techniques require two assistant ports when the assistant performs division of the hilar structure with a hand-held stapler and retraction of the lung (14).…”

Commentary: A surgical shotgun?

“…This may be particularly true in the conduct of roboticassisted operations, in which the vein is often divided as the last step. 6,7 With increasing adoption of minimally invasive techniques including thoracoscopic and roboticassisted resections, lung retraction and manipulation also may represent an interesting area of investigation. As alluded to by the authors, tumor shedding may vary with different techniques of lung handling.…”

Commentary: To flip or not to flip: Approaching the minimally invasive lobectomy

“…The robotic platform holds promise in increasing the adoption of minimally invasive lobectomy, offering improved dexterity, better visualization, and shortened learning curve compared with VATS. 5 In their excellent video atlas, Sasankan and colleagues 6 describe their robotic right upper lobectomy technique using a posterior-to-anterior approach that is reminiscent of the traditional open lobectomy approach through a posterolateral thoracotomy. 6 …”

“… 5 In their excellent video atlas, Sasankan and colleagues 6 describe their robotic right upper lobectomy technique using a posterior-to-anterior approach that is reminiscent of the traditional open lobectomy approach through a posterolateral thoracotomy. 6 …”