A New Approach for Robot-assisted Left Upper Lobectomy: Single-Directional via Interlobar Fissure

Abstract

Background

With the introduction of robot-assisted thoracoscopic surgery (RATS), many lung surgeries can be well exposed and completed. However, the removal of the upper lobe of the left lung still puzzles many clinicians because of its anatomical characteristics, especially in patients with large tumors and difficult flip of lung lobes, or patients with enlarged lymph nodes or portal nail lymph nodes. In this article, we introduce a new surgical approach, namely, “single-directional lobectomy via interlobar fissure (SDLIF),” for the rapid and safe removal of the left upper lung under RATS.

Materials and Methods

We retrospectively analyzed 35 patients who underwent left upper lobectomy for lung cancer using SDLIF approach under Da Vinci RATS. We counted the following indicators such as the operation time, intraoperative bleeding, number of lymph node dissection, incidence of postoperative lung air leakage, postoperative hospital stay, tumor types, pathological stages, resection completeness, and other complications.

Results

With this surgical method, all patients were successfully operated without serious complications. This procedure reduced the amount of high-value consumables used and decreased the operation time. Besides, compared with a previous study, it reduced the amount of intraoperative blood loss.

Conclusion

SDLIF is a simple, easy-to-learn, fast and safe lobectomy, which is especially suitable for patients with large tumors and difficult flip of lung lobes, or patients with enlarged lymph nodes or portal nail lymph nodes, and is a surgical technique worth promoting and spreading.

Keywords

surgical approach - left upper lobectomy - robot-assisted - single-directional - interlobar fissure

Authors' Contributions

R.L. contributed to manuscript editing, data acquisition, and data analysis. N.C. contributed to the definition of intellectual content. X.T. contributed to data acquisition and data analysis. J.L. contributed to data acquisition and manuscript review. W.H. contributed to study concepts, study design, and manuscript review.

Data Availability Statement

The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants, but are available from the corresponding author.

Ethical Approval

This study protocol was reviewed and approved by Medical Ethics Committee, Zhongnan Hospital of Wuhan University, approval number 2022015K.

^* Contributed equally to this work and should be considered co-first authors.

Publication History

Received: 21 December 2024

Accepted: 13 June 2025

Article published online:
14 July 2025

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