Useful robotic stapler technique for division of intersegmental plane in robotic portal pulmonary segmentectomy

Abstract Objectives: Robot assisted thoracoscopic (RATS) segmentectomy is becoming increasingly common due to the expanded indications for segmentectomy and the widespread adoption of robotic surgery. Precise division of intersegmental plane is necessary to ensure oncologic margins from the tumor and preserve lung function. In this study, we present our strategy for accurately dividing the intersegmental plane using a robotic stapler and review the surgical outcomes. Methods: RATS portal segmentectomy was performed using Da Vinci Xi system and the intersegmental plane was dissected using robotic stapler. During dissection of the pulmonary hilum, the silk threads stapled with the blood vessels and bronchi were pulled to widen the view of the pulmonary hilum and outline the correct line of dissection. We evaluated the perioperative outcomes of 92 patients who underwent RATS portal segmentectomy using this technique between May 2020 and January 2023. These results were compared with 82 patients who underwent complete video-assisted thoracoscopic surgery (CVATS) during the same period. Results: The operative time and console time was 162 minutes and 97 minutes, respectively. No intraoperative complication occurred, andpostoperative complications were observed in 4 cases (4.3%). The operative time, blood loss, postoperative complications and maximum incision size were significantly lower in RATS compared to CVATS. However, RATS required a significantly higher number of staplers than CVATS. Conclusions: Our technique for dividing theintersegmental plane using a robotic stapler in RATS portal segmentectomy was found to be safe and effective.