Routine conventional leak test is not required for robotic major pulmonary resections.

Objective: We retrospectively evaluated whether or not conventional air leak testing is necessary in robotic major pulmonary resections.

Methods: After excluding patients who received 2 or more days of postoperative drainage for chylothorax or excessive pleural effusion, 578 patients who underwent major pulmonary resection using minimally invasive approaches between February 2019 and November 2023 at our institution were included in this study. All patients were divided into two groups including thoracoscopic (n = 471) and robotic (n = 107) approaches.

A robotic fissureless right upper lobectomy using a posterior approach.

The fissureless technique in a lobectomy is considered useful to avoid postoperative prolonged air leak when a fissure is fused because it is not dissected. In particular, this technique has been used most frequently in right upper lobectomies because the dense fissure was most frequently found between the right upper and middle lobes. We believe that the surgical steps in this technique should be modified depending on the surgical approach, although the concept that the hilar structures, including the pulmonary vessels and bronchi, are each transected prior to division of a dense fissure is the same.

A robotic left S6 and S1/2c segmentectomy using the lung-inverted approach.

In pulmonary segmentectomy, the dominant pulmonary arteries are traditionally divided at the fissure. However, this approach sometimes leads to inadvertent injury to the pulmonary artery and prolonged air leak when the fissure is fused. To overcome these problems, by taking advantage of the good visualization provided by robotic surgery, we have adopted the lung-inverted approach without fissure dissection for segmentectomy.