Review Article

The role of robotic segmentectomy for non-small cell lung cancer

Anil Gokce*, Yucel Akkas and Bulent Kocer

Published: 06 October, 2020 | Volume 4 - Issue 1 | Pages: 042-046

Segmentectomy may be applied to all segments; superior segmentectomies (lower lobe superior segments for both lungs), lingulectomies (two segments forming lingulas of upper left lobe) and basal segmentectomies (segments other than superior segment for both lungs). In lung segment resections; segmentectomy has an equivalent morbidity, recurrence and survival rate compared to lobectomy, in patients with stage I lung cancer, tumors smaller than 2 cm and within the segmental anatomical limits. Segmentectomy also contributes more to preserving lung function and exercise capacity than lobectomy. In tumor resection; especially in patients with advanced age, insufficient performance or insufficient cardiopulmonary reserve, 2 cm in diameter and acceptable segmental margins may be provided.

Limited long-term results show oncological results of robotic approach similar to open and VATS approaches. Robotic approach facilitates surgery with more intuitive movements, greater flexibility and high definition, three-dimensional vision. However, high cost and lack of touch sense are main disadvantages of robotic surgery. New studies are needed to assess quality of life, morbidity, oncological results and cost effectiveness. However, considering development of technology in our age and fact that many surgical robot brands will be released in the near future, it is predicted that disadvantages of robotic surgery will be minimized in the near future.

This article reviews experience of segmentectomy in non-small cell lung cancer and discusses benefits and limitations of robotic segmentectomy.

Read Full Article HTML DOI: 10.29328/journal.ascr.1001052 Cite this Article Read Full Article PDF


Segmentectomy; Robotic segmentectomy; Robot assisted thoracic surgery; Minimal invasive surgery


  1. Kalaycı G, Dilege S. Lung Resections. In: Yuksel M, Kalaycı (eds). Thoracic Surgery, 1st Edition. Istanbul: Bilmedya Group; 2001; 133-142. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009068/  
  2. Jensik RJ, Faber LP, Milloy FJ, Monson DO. Segmental resection for lung cancer- a fifteen-year experience. J Thorac Cardiovasc Surg. 1973; 66: 563-572. PubMed: https://pubmed.ncbi.nlm.nih.gov/4356889/  
  3. Read RC, Yoder G, Schaeffer RC. Survival after conservative resection for T1 N0 M0 non-small cell lung cancer. Ann Thorac Surg. 1990; 49: 391-400. PubMed: https://pubmed.ncbi.nlm.nih.gov/2155592/  
  4. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995; 60: 615-623. PubMed: https://pubmed.ncbi.nlm.nih.gov/7677489/  
  5. Nakamura H, Kawasaki N, Taguchi M, Kabasawa K. Survival following lobectomy vs limited resection for stage I lung cancer: a meta-analysis. Br J Cancer. 2005; 92: 1033-1037. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361939/  
  6. De Zoysa MK, Hamed D, Routledge T, Scarci M. Is limited pulmonary resection equivalent to lobectomy for surgical management of stage I non-small-cell lung cancer? Interact Cardio Vasc Thorac Surg. 2012; 14: 816-820. PubMed: https://pubmed.ncbi.nlm.nih.gov/22374287/  
  7. Harada H, Okada M, Sakamoto T, Matsuoka H, Tsubota N. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg. 2005; 80: 2041-2045. PubMed: https://pubmed.ncbi.nlm.nih.gov/16305841/  
  8. Kilic A, Schuchert MJ, Pettiford BL, Pennathur A, Landreneau JR, et al. Anatomic segmentectomy for stage I non-small cell lung cancer in the elderly. Ann Thorac Surg. 2009; 87: 1662-1668. PubMed: https://pubmed.ncbi.nlm.nih.gov/19463574/  
  9. Donahue JM, Morse CR, Wigle DA, Allen MS, Nichols FC, et al. Oncologic efficacy of anatomic segmentectomy in stage IA lung cancer patients with T1a tumors. Ann Thorac Surg. 2012; 93: 381-388. PubMed: https://pubmed.ncbi.nlm.nih.gov/22209375/  
  10. Kates M, Swanson S, Wisnivesky JP. Survival following lobectomy and limited resection for the treatment of stage I non-small cell lung cancer ≤1 cm in size: a review of SEER data. Chest. 2011; 139: 491-496. PubMed: https://pubmed.ncbi.nlm.nih.gov/20576736/  
  11. Wolf AS, Richards WG, Jaklitsch MT, Gill R, Chirieac LR, et al. Lobectomy versus sublobar resection for small (2 cm or less) nonsmall cell lung cancers. Ann Thorac Surg. 2011; 92: 1819-1825. PubMed: https://pubmed.ncbi.nlm.nih.gov/22051277/  
  12. Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Onco. 2011; 6: 244-285. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513953/  
  13. Pettiford BL, Landreneau RJ. Role of sublobar resection (segmentectomy and wedge resection) in the surgical management of non-small cell lung cancer. In: Thoracic Surgery (3rd Edition). Patterson GA, Cooper JD, Deslauriers J, Lerut AEMR, Luketich JD, Rice TW, Pearson FG (Eds). Elsevier, Philadelphia, USA, 2008: 869-878.
  14. Yang CF, D'Amico TA. Open, thoracoscopic and robotic segmentectomy for lung cancer. Ann Cardiothorac Surg. 2014; 3: 142-152. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988303/  
  15. Sezen CB, Aker C. VATS Lobectomy, Segmentectomy, Pneumonectomy. Updates on Pulmonary Diseases. 2020; 8: 37-42.
  16. Veronesi G. Robotic lobectomy and segmentectomy for lung cancer: results and operating technique. J Thorac Dis. 2015; 7: 122-130. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419035/  
  17. Toker A, Ayalp K, Uyumaz E, Kaba E, Demirhan O, Erus S. Robotic lung segmentectomy for malignant and benign lesions. J Thorac Dis. 2014; 6: 937-942. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120181/  
  18. Wei B, Cerfolio R. Technique of robotic segmentectomy. J Vis Surg. 2017; 14; 3: 140. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676209/  
  19. Pardolesi A, Park B, Petrella F, Borri A, Gasparri R, et al. Robotic anatomic segmentectomy of the lung: technical aspects and initial results. Ann Thorac Surg. 2012; 94: 929-934.
  20. Kagimoto A, Tsutani Y, Izaki Y, Handa Y, Mimae T, Miyata Y, Okada M. Initial experience of robotic anatomical segmentectomy for non-small cell lung cancer. Jpn J Clin Oncol. 2020; 50: 440-445. PubMed: https://pubmed.ncbi.nlm.nih.gov/32115630/  
  21. Demir A, Ayalp K, Ozkan B, Kaba E, Toker A. Robotic and video-assisted thoracic surgery lung segmentectomy for malignant and benign lesions. Interact Cardiovasc Thorac Surg. 2015; 20: 304-309. PubMed: https://pubmed.ncbi.nlm.nih.gov/25476458/  
  22. Zhou Q, Huang J, Pan F, Li J, Liu Y, et al. Operative outcomes and long-term survival of robotic-assisted segmentectomy for stage IA lung cancer compared with video-assisted thoracoscopic segmentectomy. Transl Lung Cancer Res. 2020; 9: 306-315. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225141/  
  23. Liang H, Liang W, Zhao L, Chen D, Zhang J, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: a meta-analysis. Ann Surg. 2018; 268: 254-259. PubMed: https://pubmed.ncbi.nlm.nih.gov/28628562/  
  24. Zhang Y, Chen C, Hu J, Han Y, Huang M, et al. Early outcomes of robotic versus thoracoscopic segmentectomy for early-stage lung cancer: a multi-institutional propensity score-matched analysis. J Thorac Cardiovasc Surg. 2020; S0022-5223(20)30226-9. PubMed: https://pubmed.ncbi.nlm.nih.gov/32113718/  
  25. Xie B, Sui T, Qin Y, Miao S, Jiao W. Comparison of short-term outcomes of lung segmentectomy by robotic-assisted and video-assisted thoracoscopic surgery. Zhongguo Fei Ai Za Zhi. 2019; 22: 767-771. PubMed: https://pubmed.ncbi.nlm.nih.gov/31874672/  
  26. Nguyen D, Gharagozloo F, Tempesta B, Meyer M, Gruessner A. Long-term results of robotic anatomical segmentectomy for early-stage non-small-cell lung cancer. Eur J Cardiothorac Surg. 2019; 55: 427-433. PubMed: https://pubmed.ncbi.nlm.nih.gov/30325403/
  27. Cerfolio RJ, Watson C,  Minnich DJ, Calloway S, Wei B. One hundred planned robotic segmentectomies: early results, technical details, and preferred port placement. Ann Thorac Surg. 2016; 101: 1089-1096. PubMed: https://pubmed.ncbi.nlm.nih.gov/26846343/

Similar Articles

  • The role of robotic segmentectomy for non-small cell lung cancer
    Anil Gokce*, Yucel Akkas and Bulent Kocer Anil Gokce*,Yucel Akkas,Bulent Kocer. The role of robotic segmentectomy for non-small cell lung cancer. . 2020 doi: 10.29328/journal.ascr.1001052; 4: 042-046
  • Impact of COVID-19 outbreak on urology practice in India
    Mahendra Singh*, Himanshu Pandey, Prateek Gupta, Gautam Ram Choudhary, Vipin Tyagi, Vijay Kumar Sarma Madduri and Nikita Shrivastava Mahendra Singh*,Himanshu Pandey,Prateek Gupta,Gautam Ram Choudhary,Vipin Tyagi,Vijay Kumar Sarma Madduri,Nikita Shrivastava. Impact of COVID-19 outbreak on urology practice in India. . 2021 doi: 10.29328/journal.ascr.1001059; 5: 011-019

Recently Viewed

Read More

Most Viewed

Read More