Right robotic-assisted thoracic surgery retrograde fissureless en bloc S2/6 bisegmentectomy

We describe a demanding procedure involving resection of a non-palpable lesion resting in the middle of the posterior aspect of the undeveloped oblique fissure, between the right S2 and S6 segments. Four ports were utilized, and the da Vinci X system was used. The resection started from the V6. Because the fissure was not complete, a tunnel was created below the B6 and towards the area between the A6 and the rest of the basal pulmonary artery. The division of the S6 segment from the lower lobe followed. After the B6 was divided, the A6 was divided separately from the A2 although they originated with a common trunk. The B2 division followed. Finally, the S2 segment was detached, completing the S2/6 bisegmentectomy. Postoperative recovery was uneventful, and the patient was discharged on post-operative day 1. The final histologic report confirmed an adenocarcinoma non-small cell lung cancer (pT1bN0M0V1PL0) with negative margins (R0). At the follow-up examination, the patient was well without cancer recurrence.