The posterior approach to robotic-assisted right upper lobectomy

In this report, Dr. Cheng and colleagues from Shanghai Chest Hospital demonstrate a very elegant robotic-assisted right upper lobectomy and lymph node dissection in a patient who presented with lung cancer and clinically positive N2 disease, but refused staging or neoadjuvant therapy. The authors are very experienced surgeons with a high volume of robotic-assisted thoracic cases at one of the busiest thoracic hospitals in the world. Their technique utilizes the third-generation robotic platform (da Vinci S, Intuitive Surgical, Sunnyvale, California, USA) and they opt to use a three-arm technique with a utility incision for the bedside assistant in the anterior 4^th intercostal space. The authors use a wound protector for this incision and do not insufflate CO₂. According to the American Association for Thoracic Surgery (AATS) consensus on robotic-assisted lobectomy nomenclature, this is an example of an RAL-3 technique (1).