Large Series of Robotic Segmentectomies: Technical Advantages of Using Indocyanine Green Dye
Dustin J. Manchester, Lana Y. Schumacher, Allegheny General Hospital, Pittsburgh, PA
OBJECTIVE: Lung cancers are being detected at smaller sizes and earlier stages due to screening and improved cross sectional imaging, Sublobar resection for lung cancers less than 2cm has been heavily debated. Two randomized phase III clinical trials designed to address this topic will result shortly. Our preference for these small tumors is robotic segmental resection.
METHODS: From May 2013-May 2017, 84 robotic segmental lung resections were performed by a single-surgeon in a teaching hospital. This is the second largest series of robotic segmentectomies in the literature. We use a dual consol Xi daVinci Robotic system, a 4-port technique, and an assistant port. Indocyanine green dye was injected following segmental vessel division to define the segmental lung parenchyma. Frozen pathology was sent in all cases; completion lobectomy was performed when margins were inadequate.
RESULTS: Median surgery time was 175 minutes. There was 1 open conversion due to pulmonary artery bleeding. 5 patients had a robotic completion lobectomy due to inadequate margins. We experienced 1 (1.2%) in-hospital death due to PEA arrest.
CONCLUSIONS: Intuitively we feel that segmental lung resection for early stage lung cancers is important to preserve normal lung parenchyma. This theoretically corresponds with improved pulmonary function post-operatively allowing for future resection as an estimated 11% of these patients will develop a second primary lung cancer. Robotic assisted segmentectomy allows for excellent visualization and precise vascular dissection. Use of indocyanine green following vascular division allows us to preserve normal lung parenchyma while still performing an oncologic resection with adequate margins.