A Robotic Right Posterior Basal and Subsuperior (S10+S∗) Segmentectomy

Abstract

Given the small volume of the subsuperior segment (S∗), the thoracic surgeon are often unaware of it, and there are only a few reports describing subsuperior segmentectomy. Here we report a successful case of right posterior basal and subsuperior segmentectomy through a robotic approach with a sufficient surgical margin. Although this type of segmentectomy is considered technically difficult, the robotic approach helped us to achieve it easily. In addition, careful examination of preoperative 3-dimensional computed tomographic bronchoangiography was important to avoid misunderstanding the anatomy when we performed this procedure.

Figure 1

(A) A preoperative computed tomographic scan showed an approximately 15-mm part solid nodular shadow (arrowhead) in the right posterior basal segment that was strongly suspected to be primary lung cancer. (B) A dominant bronchus was found in the subsuperior segment. (C) The pattern of pulmonary vessels and bronchial branches was identified on preoperative 3-dimensional computed tomographic bronchoangiography.

Figure 2

(A) Preoperative simulation showed that a right posterior basal and subsuperior segmentectomy would provide a sufficient surgical margin (26.8 mm). (B) Preoperative simulation showed that posterior basal segmentectomy would not provide a sufficient surgical margin (8.5 mm). The arrowheads indicate virtual intersegmental planes in each segmentectomy.

Figure 3

Details of the surgical steps (1-8) in the right posterior basal and subsuperior segmentectomy.