A robotic fissureless en bloc resection of left S6 and S1+2a+b for lung cancer located at an incomplete fissure

The fissureless technique is useful for avoiding postoperative air leaks after pulmonary lobectomy or segmentectomy when the interlobar fissure is incomplete or fused. This technique is also useful for lung cancers with interlobar invasion or located in incomplete or fused fissures. In a recent case, we successfully utilized robotic-assisted thoracoscopic surgery to perform the fissureless technique on a patient diagnosed with lung adenocarcinoma. The tumour was located in the left superior segment (S6) and had spread beyond the incomplete fissure towards the apicodorsal segment (S1+2). The use of the fissureless technique allowed us to achieve a sufficient tumour margin, which is crucial for reducing the risk of recurrence. The pathological examination confirmed a diagnosis of node-negative papillary adenocarcinoma with pleural invasion. The patient experienced no recurrence at three years postoperatively. En bloc combined segmentectomy using the fissureless technique is useful to ensure adequate tumour margins for lung cancer arising in incomplete or fused fissures. Robotic surgery is suitable for this technique, which proceeds from a single direction.