Utility of basal artery clamping in robot-assisted pulmonary segmentectomy involving the superior segment of the lower lobe

BACKGROUND When a tumor located in the superior segment of the lower lobe (S6) is close to the intersegmental plane of the basal segment, the basal artery must be sufficiently dissected distally to secure a surgical margin. In these situations, we perform basal artery clamping. This study aimed to evaluate the usefulness of basal artery clamping in robot-assisted pulmonary segmentectomy involving the S6 segment. METHODS Among 65 patients who underwent robotic-assisted lung segmentectomy, including the S6 segment at our institute between 2017 and 2024, we investigated the characteristics of 8 patients who underwent basal artery clamping using a bulldog clamp. RESULTS Tumor localization was central in seven cases and peripheral in one case. Five patients underwent right S6 segmentectomy, two underwent combined right S6 and posterior basal segmentectomy, and one underwent left S6 segmentectomy. Basal artery clamping was performed to facilitate peripheral dissection or division of basal artery branches before intersegmental plane resection in all cases, and to enable safe transection of basal artery branches adjacent to the divided intersegmental staple line in four cases. The median surgical margin was 16 mm (range, 6–30). The median operation time was 184 min (range, 155–228), and the median blood loss was 5 mL (range, 3–10). No cases required conversion to open thoracotomy. The 90-day mortality rate was 0%. CONCLUSIONS Basal artery clamping is a useful technique in robot-assisted pulmonary segmentectomy involving the S6 segment, particularly when the tumor is close to the intersegmental plane of the basal segments.