Robotic Right Middle Lobectomy and Mediastinal Lymph Node Dissection for Adenocarcinoma

1. Introduction

2. Bronchoscopy

3. Patient Setup

4. Placement of Ports

5. Robot Docking

6. Mediastinal Lymph Node Dissection

1. Rule Out Obvious Metastasis
2. Take Down any Adhesions
3. Take Down Inferior Pulmonary Ligament and Resect Inferior Pulmonary Hilar Lymph Nodes
4. Posterior Hilum and Subcarinal Lymph Nodes
5. Superior Hilum and Right Paratracheal Nodes

7. Middle Lobectomy

1. Anterior Hilum and Venous Anatomy
2. Major Fissure and Middle Lobe Bronchus
3. Further Lymph Node Dissection to Elucidate Anatomy
4. Division of Middle Lobe Vein
5. Isolation and Division of Middle Lobe Bronchus
6. Isolation and Division of Middle Lobe Pulmonary Artery Branch
7. Parenchymal Division of Upper Lobe Wedge Near Margin
8. Parenchymal Division Along Pulmonary Artery for Better Margin
9. Use ICG to Visualize the Minor Fissure
10. Parenchymal Division at Minor Fissure to Complete Resection

8. Hemostasis

9. Specimen Extraction and Robot Undocking

10. Gross Examination of Specimen

11. Closure

12. Post-op Remarks