Application of Cautery Ligating Vessels in Uniport Robot-Assisted Segmentectomy

Background: In multiport robot-assisted thoracic surgery (RATS) (Da Vinci), the ligation of small blood vessels may be performed by the surgeon or assistant using a Hemlock or clamps.After Gonzales initiated uni-port RATS (URATS), the surgeons often use the Maryland Bipolar Forceps in ligation to avoid the assistant's difficulty in operating space and angle.We prefer to use the cautery for dissection, so we explore the method of ligation of the vessels with the hook and barbed wire (Stratafix Spiral).Methods: Dissecting along the sheath of the interlobar artery to preserve the anatomy of the nodule and target vessels.A 1 cm length of perivascular gap was dissected and left to ensure the threading of the barbed wire and the safe stump.Preparation of the wire, it threaded the coil into a circle, so it can be placed on the tip of the hook for pulling and knotting.Cut the needle end about 5 cm.The bipolar forceps delivered the coil through the perivascular gap, and the cautery hooked out of the coil.The forceps and hook completed the looping and tightening of the surgical knot.The oblique fissure was dissected and part of the posterior segment was excised.After exposing and severing the dorsal artery, dorsal segmentectomy ensured a complete removal of the nodule, which located right between the interlobar vein and dorsal artery.Results: Ligating and severing the target interlobar vein and dorsal artery, the ground glass nodule was completely resected at a safe range.And the pathology was microinvasive adenocarcinoma. Conclusion:The barbed wire knotting is reliable and can withstand large pulling force, without knot shifting and vessel tearing.Using a hook to ligate vessels increases flexibility in URATS.To save instruments such as Maryland forceps and needle holders in ligation have carbon reduction values as well.