James W. Klena, M.D., presents a case of a 72 year-old male with lung cancer that undergoes a robotic-assisted thoracoscopic lobectomy. Dr. Klena discusses why this treatment approach was chosen and narrates the steps of the procedure.
My name is James Gonna I am a cardio thoracic surgeon with an interest in thoracic surgery with the Sentara mid atlantic cardio thoracic surgical group. Um I work at the Sentara Heart Hospital in Norfolk and at Sentara Virginia Beach General Hospital in Virginia Beach. I would like to present a case to you today. Um this is a 72 year old gentleman who had a very marginal pulmonary function studies and who likely would not have been a candidate for an open procedure because of his poor pulmonary function studies. Um he may have been a candidate for a video assisted the orcas coptic surgery but the robot allows the surgeon to have a little bit more precise um control of the operative field and also has improved optics in my opinion compared to video assistant or endoscopic surgery. Um Perhaps most importantly the robot is a very good tool for doing um segment checked. Amis. Return to work for patients much sooner than they would with open surgery or even video assisted surgery. So so this is the surgical team in the operating room for a robotic lumpectomy. The patient we described, you can see the team set up with a physician assistant, a surgical assistant and the scrub nurse. So this is the trucker's sites that allow us to work through the chest wall being set. We use a special camera that allows three D. Visualization of the field which is much different than all other surgical procedures. That is the console with me sitting at it operating the surgical arms which you see moving in this clip the da Vinci X. I. Robot is superior than its previous counterparts and that is a much more flexible machine with the arms being much more dynamic. Here we see intra plural pictures um with the tumor being visualized at about 12 o'clock and here is an example of a bipolar Kateri utilizing uh electricity to separate the fissures and separate the lower lobe from the upper lobe. Here we have the fisher dissection continuing um and the pulmonary already lies underneath. With this being an example of an endo thoracic stapler um transacting one of the branches of the pulmonary artery. So the the beauty of the system is that the instruments all have 7° of rotation very similar to a human hand. Thus the name intuitive of the company. Um it is very very much like open surgery using instruments remotely in the body. So this is transaction of the pulmonary artery. This is a scene where the capability of the robot is shown for a segment ectomy. The green background on that piece of lung was um I. C. G. Which is given and seen through a special lens on the camera to allow demarcation of where blood flow is. And here we're taking the pulmonary vein and again you can see the flexibility of the stapler which allows us to move in several planes inside the chest and allows us to have very precise uh maneuvering to uh mobilize these delicate structures and transact them. Um again the beauty of the surgery is these are all done through small, about 2" incisions. We do not have to spread the ribs space. So the pain that normally follows thoracic surgery due to intercostal nerve injury is extremely minimal due to this procedure. Thus their post op pain is kept to a low um ironically at the end of the case we have to make one of the incisions bigger to remove the specimen. So this is the train, this is the removed lower lobe uh and the physician assistant is marking the nodule to uh identify it for the pathologist. So uh it can be read by frozen section. So the the robot allows very very minimal dissection and extremely limited incisions on the body. So muscle layers and the intercostal spaces are not interrupted.
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