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  • 780
  • 2015-01-14

Complex left upper lobectomy with lymphadenectomy by robotic assisted thoracoscopy (CPRL-3) for cT2N2 non-small-cell lung carcinoma (NSCLC)

Epublication WebSurg.com, Jan 2015;15(01). URL:
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This video demonstrates a left upper lobectomy for the management of a proximal cT2N2M0 lung tumor. It is usually considered a contraindication of minimally invasive surgery. Our aim is to show the feasibility and the safety of the procedure. Robotic surgery will allow for more minimally invasive indications. The tumor lies proximally to the left trunk of the pulmonary artery which could be a contraindication to a minimally invasive surgery. A CT-scan combined with a 3D reconstruction helps to rule out the existence of pulmonary artery invasion. Hilar adenopathies as well as adenopathies of the aortopulmonary window present a hypermetabolism on PET-scan. No neoadjuvant chemotherapy is performed since a R0 surgery is potentially feasible immediately and can be associated with a full lymphadenectomy. This video presents our technique of robotically assisted left upper lobectomy combined with a lymph node dissection. We have attempted to standardize our lung resection technique using 6 areas of dissection to gain in efficacy and save time. The first operative step is to free the triangular ligament and to sample potential lymph nodes (station No. 9). A hilar lymphadenectomy (lymph node station No. 10) is then performed using a posterior approach first followed by a subcarinal approach (lymph node #7, by skeletonizing the pulmonary artery and the left main bronchus. The third step of the procedure is to dissect the fissure to skeletonize the pulmonary artery and its lingular branches as well as branches of the posterior fissure, dissection of lymph node stations No. 11 is performed simultaneously. The elements of the hilum are then approached using an anterior approach. The superior pulmonary vein is dissected. The roof of the hilum is then freed. The left upper bronchus is divided last. Dissection of lymph node station No. 5 completes the procedure with preservation of the left recurrent nerve Abbreviation: CPRL-3: complete portal robotic lobectomy using 3 arms