Robotic Lobectomy: Right Upper Lobectomy

Evidence favors a minimally invasive approach for early-stage lung cancer. Video-assisted thoracoscopy is the technique most commonly used today, but the robotic approach is considered the future of minimally invasive surgery, above all because of its high-definition stereoscopic view, improved dexterity because of increased degrees of movement of the instruments, lack of the fulcrum effect, tremor filtration, and greater surgeon comfort. Two techniques have been described for robotic lobectomy: robotic-assisted thoracoscopic surgery (RATS) and complete portal robotic lobectomy. The RATS technique necessitates an anterior approach to the hilum and does not routinely use CO2 insufflation; complete portal robotic lobectomy uses a posterior approach, with the specimen extracted at the end of surgery via a subcostal, transdiaphragmatic route. This article provides a step-by-step description of right upper lobectomy using a 4-arm RATS approach. The procedure is feasible and safe to perform for experienced surgeons. Although the incidence of severe intraoperative complications is low but potentially life-threatening, we believe the technique is valid for the minimally invasive treatment of lung cancer. Nonetheless, operator comfort should be the main factor influencing the choice of technique.