Page 10 - Read Online

Durand. Mini-invasive Surg 2019;3:35 I http://dx.doi.org/10.20517/2574-1225.2019.31 Page 5 of 9

length). Four to six wires were placed before starting to knot. A double loop was performed for the 1st knot
to help tighten the knot.

For superior bilobectomy, pericardium section below the inferior pulmonary vein was achieved with the
spatula to release the tension of the anastomosis. This could also be performed for RUL.

S6 sleeve segmentectomy
TM
For sleeve segmentectomy, green light (FireFly ) was used to ensure accurate parenchymal margin
resection. After section of vascular and bronchial structure, 8 mL (i.e., 15 mg of indocyanine green)
were injected as an iv flush and rinsed with 10 mL of saline. About 20 s after injection, the green light
was turned on to spot the margin of parenchymal resection. The margins were marked with the bipolar
grasper. The grasper was previously placed in the right-hand port. Then, the specimen was placed in an
Endobag®.

The complementary section of the bronchus was done with curved scissors through the fissure exposure
and sent for frozen section analysis.

For better control of the bronchial section, the third arm was anteriorly tracking the basal pyramid trunk
with a silicone loop (10-cm cut blue loop).

As for ML anastomosis, the posterior approach was preferred as it ensured the natural encounter of the
two borders and moved the artery away during suturing. The same steps of suture were performed as RUL
anastomosis.

Data analyses
Quantitative data are presented as the number of observed values, mean ± standard deviation, median,
and range (min-max), while qualitative data are presented as the number of observed values. Complication
[5]
severity was evaluated with Clavien Dindo classification .

RESULTS
During this period (February 2014 to August 2019) in our institution, 582 patients underwent robotic
thoracic procedures. In this cohort, 486 anatomical lung resections were performed, which involved 351
lobectomies or bilobectomies and 135 segmentectomies. Among these patients, 10 received a bronchial
sleeve, i.e., 2% of the anatomical lung resections. The first bronchial sleeve was done on Patient 219. The
main characteristics of the patients and procedures are reported in Table 1 in chronological order. The
TM
TM
first 5 procedures were performed with the Da Vinci Si system and the last five with the Da Vinci Xi
system.
All patient had accurate pathology diagnosis of the lesion preoperatively. All surgeries occurred on the
right lung. None of the patients involved pathological nodes. All resection margins were R0. The procedure
details and outcomes are reported in Table 2 in the same order as Table 1.

No major events occurred preoperatively. Surgery duration was from 121 to 243 min. No blood transfusion
was required during hospital stay. No bronchial fistula occurred.

DISCUSSION
Bronchial sleeve procedures are complex and rare surgeries. The benefit of the enhanced vision and hand
tool of the robotic system is significant for these surgeries. The principle of telemanipulation surgery is