A 50-year-old woman was found to have a pulmonary nodule for 4 years detected by computed tomography (CT), Chest CT (Figure 1) showed ground glass opacity (GGO) in the S1+2 segment of left upper lobe. The lesion size increased from 5 to 8 mm during follow-up. The patient’s did not have any clinical syndrome and her cardiopulmonary function, blood gas analysis and laboratory tests were normal. There was no positive sign or supraclavicular lymph node enlargement on physical examination. She has no medical history.
Anesthesia and body position
The patient received general anesthesia by double-lumen endotracheal intubation and was placed in the lateral decubitus position and in a jackknife position, with single-lung (right) ventilation (1) (Figure 2).
A 1.5-cm camera port (for a 12-mm trocar) was created in the 8th intercostal space (ICS) at the left mid axillary line, and three separate 1.0-cm working ports (for 8-mm trocars) were made in the 6th ICS (#1 arm) at the left anterior axillary line, the 7th ICS (#2 arm) at the left posterior axillary line, and the left 8th ICS (#3 arm), 2 cm from the spine. An auxiliary port (for a 12-mm trocar) was made in the 8th ICS near the costal arch (2) (Figure 3).
Installation of the operation arms
The robot Patient Cart is positioned directly above the operating table and then connected. The 2# arm was connected with bipolar cautery grab and the 1# arm was connected with a unipolar cautery hook. Incision protector was applied in the auxiliary port (3).
Postoperative treatments included anti-inflammatory and phlegm-resolving treatment. The thoracic drainage tube was withdrawn 2 days after surgery, and the patient was discharged 3 days after surgery. No complications were observed during hospitalization. Pathologic diagnosis was microinvasive adenocarcinoma 0.8 cm in the apex posterior segment of the left upper pulmonary lobe. No metastasis was seen at the bronchial stump or in the sampled lymph nodes. The postoperational pathologic stage was pT1aN0M0 (IA stage).
Conflicts of Interest: The authors have no conflicts of interest to declare.
Informed Consent: Written informed consent was obtained from the patient for publication of this manuscript and any accompanying images.
- Nomori H, Okada M. Illustrated Anatomical Segmentectomy for Lung Cancer. Tokyo: Springer, 2011.
- Wang S. The Robotic Thoracic Surgery. China: AME Publishing Company, 2015.
- Liu J, Lu W, Zhou X. Video-assisted thoracic surgery left S1+2+3 segmentectomy for lung cancer. J Thorac Dis 2014;6:1837-9.
Cite this article as: Du H, Yang S, Guo W, Jin R, Zhang Y, Chen X, Wu H, Han D, Chen K, Xiang J, Li H. Robotic thoracic surgery: S1+2 segmentectomy of left upper lobe. AME Med J 2017;2:7.