Video atlas of pulmonary segmentectomy: robotic-assisted right S1 segmentectomy with 3-dimensional imaging

Robotic-assisted thoracic surgery has seen a significant rise in recent years, particularly for complex lung cancer resections. Robotic surgery offers advantages such as three-dimensional visualization, improved tissue manipulation and precise instrument control. In conjunction with other minimally invasive techniques, robotic-assisted thoracic surgery is increasingly preferred over traditional open thoracotomy for lung cancer resections. This development has been suggested to reduce postoperative morbidity, shorten hospital stay and hasten postoperative recovery. Although pulmonary segmentectomy can present technical challenges, the use of three-dimensional reconstruction imaging allows for detailed preoperative visualization of the tumour and the adjacent bronchovascular structures. This enables more accurate and anatomically tailored resections. However, despite its potential, the discussions of the integration of virtual three-dimensional lung reconstruction into routine thoracic surgical practice remain limited in the current literature. We present a video atlas series of robotic-assisted segmentectomies guided by three-dimensional reconstruction imaging. This video tutorial includes a step-by-step guide for performing a right S1 segmentectomy for a patient presenting with a right upper lobe tumour. Introduction Hide - The adoption of robotic-assisted thoracic surgery (RATS) has grown significantly due to its high-definition three-dimensional (3D) visualization, instrument dexterity and refined movements with minimal tissue trauma [1]. Additionally, RATS offers enhanced ergonomics for the surgeon relative to video-assisted thoracic surgery [2, 3]. Despite the advantages of RATS for lung cancer resection, performing a segmentectomy, especially within anatomically complex regions such as the right upper lobe, remains challenging. Segmentectomy of the apical segment (S1) presents unique technical challenges due to the variability in segmental anatomy and the proximity of critical bronchovascular structures [2]. To address these complexities, preoperative 3D reconstruction imaging can enable detailed anatomical assessment of the tumour and surrounding vasculature [4], which allows for precise surgical mapping and improved intraoperative orientation [4, 5]. These features enhance overall preoperative planning. The application of 3D reconstruction imaging to pulmonary segmentectomies still remains under-represented, with little in the literature about its use in challenging cases [5, 6]. In this video tutorial, we present another contribution to an atlas series of robotic-assisted segmentectomies, guided with 3D reconstruction imaging. It involves a step-by-step guide for performing a right S1 segmentectomy for a right upper lobe tumour.