Video analysis of intraoperative complications and management in robotic lung segmentectomy

Abstract OBJECTIVES Robotic-assisted thoracic surgery segmentectomy is increasingly used; however, comprehensive reports on robotic-specific intraoperative complications remain limited. This study analyzed intraoperative complications during robotic-assisted lung segmentectomy across different indications, emphasizing factors unique to robotic surgery—limited visualization, lack of tactile feedback, instrument interference, and team communication—and described effective management strategies derived from detailed video-based review. METHODS A retrospective analysis of 215 consecutive patients (169 with primary lung cancer, 38 with metastatic lung tumors, and 8 with other diseases) who underwent robotic-assisted thoracic surgery segmentectomy between July 2020 to March 2024 was conducted. Operative records and videos were reviewed to identify intraoperative complications, and detailed video-based analyses were performed to determine injury mechanisms and causes. RESULTS Intraoperative complications occurred in 19 patients (8.8%), primarily involving injuries to the pulmonary artery (n = 9, 4.2%), bronchi (n = 4, 1.9%), pulmonary vein (n = 2, 0.9%), and pleura (n = 4, 1.9%). Robotic-specific complications, attributed to limited visualization, lack of tactile feedback, stapler-related tension, instrument interference, and miscommunication, accounted for 3.3% (7 cases). All complications were managed successfully without blood transfusion or thoracotomy conversion using fibrin sealant patches, direct suturing, or additional subsegmental resection. CONCLUSIONS Video analyses identified robotic-specific challenges—limited visualization, lack of tactile feedback, instrument trouble, and miscommunication. Targeted refinements in port positioning, stapling techniques, and structured simulation training improved the safety of robotic-assisted segmentectomy.