The patient was a 71-year-old man admitted because of cough and expectoration lasting a week. Chest computed tomography (CT) (Figure 1) showed a nodular shadow on the right upper lobe of the lung. The local hospital considered the possibility of inflammation, and cough improved after anti-inflammatory treatment. A second CT scan showed that the lesions did not shrink. The patient even visited our hospital again. Positron emission tomography (PET)-CT findings were highly suggestive of lung cancer. The patient̓ s cardiopulmonary function, blood gas analysis, and laboratory tests were normal. There was no positive sign or supraclavicular lymph node enlargement on physical examination. He had a history of diabetes (5 years). Twenty years previously, he underwent surgery for the gallbladder stones.
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 (left) ventilation (1) (Figure 2).
A 1.5-cm camera port (for a 12-mm trocar) was placed in the 8th intercostal space (ICS) at the right middle axillary line, and three separate 1.0-cm working ports (for 8-mm trocars) were made in the 5th ICS (#1 arm) at the right anterior axillary line, the 8th ICS (#2 arm) at the right posterior axillary line, and the right 8th ICS (#3 arm), 2 cm from the spine. An auxiliary port (for a 12-mm trocar) was made in the 7th ICS near the costal arch (2) (Figure 3).
Installation of the surgical arms
The robot patient cart was positioned directly above the operating table and then connected. The #2 arm was connected to a bipolar cautery forceps, and the #1 arm was connected to a unipolar cautery hook. An incision protector was used in the auxiliary port (3).
Postoperative treatments included anti-inflammation 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 The thoracic drainage tube was withdrawn 2 days after surgery, and the patient was discharged 3 days after surgery.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. Pathological diagnosis was invasive adenocarcinoma (2.0 cm × 1.5 cm × 1.0 cm) in the right upper pulmonary lobe. No metastasis was seen at the bronchial stump or the sampled lymph nodes. The pathological stage: 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.
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- Cerfolio RJ, Bryant AS. Robotic-assisted pulmonary resection - Right upper lobectomy. Ann Cardiothorac Surg 2012;1:77-85.
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-assisted right upper lobectomy. AME Med J 2017;2:6.