Robotic VATS Left Lower Lobectomy + Systematic Lymphadenectomy

Abstract:

TITLE : ROBOTIC VATS LEFT LOWER LOBECTOMY + SYSTEMATIC LYMPHADENECTOMY

The video has three parts

Part 1: The technical aspects of robotic lung surgery

1.Patient position : standard right lateral with table break at thorax and padding to prevent neurapraxia

2.Port position : R1 ;C;R2 and R3 ports in 7th ICS in mid clavicular; anterior axillary line; posterior axillaryline and 2 inches above the spine respectively with palm breadth between each.

Assistant port triangulated with C and R2 and placed supra diaphragmatically.

3. Docking : the patient cart comes from the head end and in an oblique way from the right shoulder.

4. Instruments : R1 ..fenestrated bipolar R2…..maryland bipolar R3 …. 5mm lung grasper C …….30 degree A…..retraction /suction.

Part 2 : The anatomical aspects of surgery

1. Posterior dissection : removal of 5,6,8,9 stations and preserving vagus nerve and RLN .
2. Anterior dissection : removal of stations 7,10 and dissection of hilum of lung
3. Oblique fissure dissection : dissection of pulmonary artery and identifying the proximal branches that supply the upper lobe and lingular lobe and station 11nodes
4. Transection : 3 steps of dissect ,sloop and staple are employed for inflow ( pulmonary artery branch to lower lobe) outflow (inferior pulmonary vein) and left lower bronchus

Part 3: The tips and take home message

1. All ports placed in same oblique line ; assistant port triangulated supra diaphragmatically
2. Use only bipolar for dissection , not monopolar or harmonic
3. Once systematic lymphadenectomy is done all structures get delineated automatically
Usage of gauze piece can tackle hemostais
4. Dissect, sloop and then staple ….the sequence for all structures

It is possible to cross the learning curve by 12th case (CUSUM curve data)

Narrated video- KS Awards entry, with PPT’s, photos, artwork and robotic surgery videos, 07:56