Effective division of the intersegmental plane using a robotic stapler in robotic pulmonary segmentectomy

Mikio Okazaki; Ken Suzawa; Kazuhiko Shien; Kohei Hashimoto; Shin Tanaka; Kentaroh Miyoshi; Hiromasa Yamamoto; Seiichiro Sugimoto; Shinichi Toyooka

doi:10.1007/s00595-024-02840-y

Effective division of the intersegmental plane using a robotic stapler in robotic pulmonary segmentectomy

Surg Today. 2024 Apr 18. doi: 10.1007/s00595-024-02840-y. Online ahead of print.

Authors

Mikio Okazaki¹, Ken Suzawa², Kazuhiko Shien², Kohei Hashimoto², Shin Tanaka², Kentaroh Miyoshi², Hiromasa Yamamoto², Seiichiro Sugimoto², Shinichi Toyooka²

Affiliations

¹ Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan. mikiookazaki@okayama-u.ac.jp.
² Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.

PMID: 38635055
DOI: 10.1007/s00595-024-02840-y

Abstract

Purposes: Robot-assisted thoracoscopic (RATS) segmentectomy is becoming increasingly common because of the expanded indications for segmentectomy and the widespread adoption of robotic surgery. The precise division of the intersegmental plane is necessary to ensure oncologic margins from the tumor and to preserve the lung function. In this study, we present a strategy for accurately dividing the intersegmental plane using a robotic stapler and review the surgical outcomes.

Methods: RATS portal segmentectomy was performed using the Da Vinci Xi system and the intersegmental plane was dissected using a robotic stapler. We evaluated the perioperative outcomes in 92 patients who underwent RATS portal segmentectomy between May 2020 and January 2023. These results were compared with those of 82 patients who underwent complete video-assisted thoracoscopic surgery (CVATS) during the same period.

Results: The operative and console times were 162 and 97 min, respectively. No intraoperative complications occurred, and postoperative complications were observed in four cases (4.3%). The operative time, blood loss, postoperative complications, and maximum incision size were significantly lower in the RATS group than in the CVATS group. However, RATS requires a significantly higher number of staplers than CVATS.

Conclusions: The division of the intersegmental plane using a robotic stapler in RATS portal segmentectomy was, therefore, found to be safe and effective.

Keywords: Pulmonary segmentectomy; Robot-assisted thoracic surgery; Robotic segmentectomy; Robotic stapler.