Robotic lobectomy: Hilum first technique

Lobectomy of the lung is performed for primary lung cancer with individual ligation of the pulmonary vasculature and bronchus along with division of the fissures. Recent estimates claim nearly 30% of lobectomy cases are performed in a minimally invasive fashion, the robotic approach of the nonrobotic minimally invasive option may have some advantages that includes a potentially more oncologic resection, less instrument movement at the chest wall that may result in less trauma to nerves and, thus, potentially less postoperative discomfort, and a simpler technique to learn and teach, more closely approximating the moves of surgery by thoracotomy. The operative setup and surgical details for each of the five lobes is described and illustrated, outlining the technique to divide the hilar structures first and then to divide the fissures. Over the 15 years of performing the technique, particular learning points are described.