Robotic left lower lobectomy for Stage IB adenocarcinoma with critical exercise capacity

This video tutorial demonstrates a robotic-assisted left lower lobectomy in a 71-year-old female with critical exercise capacity. Preoperative evaluation revealed a 32 mm cavitated tumour in the left lower lobe. While pulmonary function tests showed a preserved forced expiratory volume in 1 second (84%), the peak oxygen consumption (VO2peak) was critically low at 5.9 mL/kg/min. Multidisciplinary assessment attributed this prohibitive value to severe musculoskeletal impairment rather than cardiopulmonary exhaustion. A robotic approach was selected to minimize chest wall trauma. The procedure involved standard hilar dissection, complete fissure division and systematic lymph node dissection. The patient experienced an uneventful recovery, with chest tube removal on postoperative Day (POD) 2 and hospital discharge on Day 3. Final pathology confirmed a 40 mm papillary adenocarcinoma (Stage IB) with micropapillary and solid components, and negative margins and lymph nodes.