2023 World Conference on Lung Cancer (Posters)-EP07.03. Pulmonary Ligament Approach for Robot-Assisted S9 or S9 and 10 Segmentectomy

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A study conducted by the Department of General Thoracic Surgery at Juntendo University School of Medicine examined the use of the pulmonary ligament approach for robot-assisted S910 segmentectomy. The researchers aimed to investigate the characteristics of this approach and identify its advantages and disadvantages.<br /><br />The study included patients who underwent S10 or S910 segmentectomy using robot-assisted thoracic surgery (RATS) between April 2017 and May 2023. The procedures were classified by approach, either pulmonary ligament or hilar approach, and findings such as operative time, blood loss, catastrophic events, complications, and mortality were compared.<br /><br />The results showed that the pulmonary ligament approach was used in 75% of RATS cases, while the hilar approach was used in only 25%. The pulmonary ligament approach had a longer operative time but less blood loss compared to thoracotomy RATS. There were no catastrophic events, mortality, or morbidities reported in either approach.<br /><br />The researchers also identified the advantages and disadvantages of the pulmonary ligament approach. The advantages included an excellent field of view, easy manipulation of vascular and bronchial exposure, and a clear separation line visible using the firefly mode. However, the positioning and stapling process posed challenges.<br /><br />To overcome the stapling difficulty, the study suggested technical tips such as checking for variations in Segment 7, exposing remaining vessels and bronchi to the periphery, and performing stapling from two directions.<br /><br />In conclusion, the study found that the single-direction method for robotic single or combined basal segmentectomy using the pulmonary ligament approach was feasible and safe. By avoiding treatment of the pulmonary artery from interlobar, the approach maintained safety for future ipsilateral revision surgeries. Success in this approach relied on understanding the anatomy of the lung, identifying V10 branches and the shape of S7, and ensuring proper exposure of vessels and bronchi.

Asset Subtitle

Mariko Fukui

Meta Tag

Speaker Mariko Fukui

Topic Early-Stage NSCLC: Limited Resections & Minimally Invasive Approaches

Keywords

pulmonary ligament approach

robot-assisted S910 segmentectomy

robot-assisted thoracic surgery

operative time

blood loss

catastrophic events

complications

mortality

advantages

disadvantages