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Gharagozloo et al. Mini-invasive Surg 2020;4:68 I http://dx.doi.org/10.20517/2574-1225.2020.60 Page 21 of 22

Figure 30. LS7-LS10 Segmentectomy: the intersegmental fissure is identified and divided using a stapler with a green cartridge

Robotic left lower lobe anatomic basal segmentectomy (S7-S10)
The approach to this segmentectomy is similar to superior segmentectomy (S6). Following the complete
mediastinal nodal dissection, the inferior pulmonary vein is encircled with a vessel loop and elevated.
Then the superior segmental vein is identified, thereby allowing for identification of the basal branch of
the inferior pulmonary vein. The basal vein (V7-10) is then divided with a stapling device with a white
cartridge. Next, the pulmonary artery is isolated in the fissure as has been described previously. The left
lower lobe pulmonary artery is identified [Figure 28]. The basal branch of the left pulmonary artery is
encircled and elevated with a vessel loop and divided with a vascular stapler. Following the division of the
A7-10, the bronchus to the basal segment (B7-10) is encircled and divided with a stapler carrying a blue
cartridge [Figure 29]. Finally the intersegmental fissure is identified and divided using a stapler with a green
cartridge [Figure 30].

CONCLUSION
Anatomic pulmonary segmentectomy in patients with early stage lung cancer is an oncologically efficacious
procedure. The surgical robot allows for precise dissection of the segmental bronchopulmonary structures
while minimizing trauma to surrounding tissues, and it allows for thorough and complete dissection of the
mediastinal nodes. Robotic segmentectomy should be considered when planning a lung sparing operation
in patients with small tumors, in elderly patients or patients with borderline lung function.

DECLARATIONS
Authors’ contributions
Contributed equally to the performance of the surgeries, collection of data and writing the manuscript:
Gharagozloo F, Meyer M