Two cases of lower lobe segmentectomy (left and right) using the lung-inverted approach in a robotic operation.

In pulmonary segmentectomy, the dominant pulmonary arteries are conventionally divided at the fissure. However, this approach sometimes leads to accidental injury of the pulmonary artery and prolonged air leaks when the fissure is fused. To overcome these problems, we have adopted the lung-inverted approach without dissection of a fissure for segmentectomy, taking advantage of the good view provided by robotic surgery. We have successfully performed a robotic left S10 or right S6 segmentectomy using the lung-inverted approach. In addition to a good postoperative course, the console time was 72 minutes for the left S10 segmentectomy and 110 minutes for the right S6 segmentectomy; these times were considered relatively short. This approach did not require repeated rotation of the lung, which may have contributed to the short operating time. A clear understanding of the anatomy was required to properly implement this approach, because each branch of the pulmonary vessels and of the bronchi was treated at the hilum. Preoperative 3-dimensional computed tomography broncho-angiography was considered useful because it allowed us to recognize the relative positions of the dominant pulmonary vessels, bronchi and other preserved structures.