Clinical Challenges in Thoracic Surgery: Robotic Segmentectomy - Lessons From 30 Years in the OR with Hopkins’ Dr. Stephen Yang

In this Thoracic Surgery episode of Behind the Knife we enjoy a conversation with world-renowned thoracic surgeon and educator, Dr. Stephen Yang, as he takes us through 30 years of experience divulging his personal tips, tricks, and pitfalls to avoid when tackling the technical nuances of mastering robotic segmentectomies. Hosts: Dr. Stephen C. Yang, MD - professor of surgery and medical oncology The Johns Hopkins Hospital Dr. Kyla D. Rakoczy, MD - PGY3 General Surgery Resident at The Johns Hopkins Hospital Learning Objectives: Understand the utility of segmentectomies for peripheral T1N0 non-small-cell-lung cancer How to prepare for robotic segmentectomy using CT scans and 3D reconstructions Learn where to place your ports and how to optimize intra-operative techniques to minimize complications after robotic segmentectomy References: Kang MW. Evolution of Lung Cancer Surgery: Historical Milestones, Current Strategy, and Future Innovations. J Chest Surg. 2025 May 5;58(3):79-84. doi: 10.5090/jcs.25.025. Epub 2025 Apr 15. PMID: 40230346; PMCID: PMC12066400. https://pubmed.ncbi.nlm.nih.gov/40230346/ 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 Sep;60(3):615-22; discussion 622-3. doi: 10.1016/0003-4975(95)00537-u. PMID: 7677489. https://pubmed.ncbi.nlm.nih.gov/7677489/ Pastorino U, Valente M, Bedini V, Infante M, Tavecchio L, Ravasi G. Limited resection for Stage I lung cancer. Eur J Surg Oncol. 1991 Feb;17(1):42-6. PMID: 1995356. https://pubmed.ncbi.nlm.nih.gov/1995356/ Liu L, Aokage K, Chen C, Chen C, Chen L, Kim YH, Lee CY, Liu C, Liu CC, Nishio W, Suzuki K, Tan L, Tseng YL, Yotsukura M, Watanabe SI. Asia expert consensus on segmentectomy in non-small cell lung cancer: A modified Delphi study. JTCVS Open. 2023 Apr 7;14:483-501. doi: 10.1016/j.xjon.2023.03.013. PMID: 37425437; PMCID: PMC10328970. https://pubmed.ncbi.nlm.nih.gov/37425437/ Galvez C, Bolufer S, Lirio F, Recuero JL, Córcoles JM, Socci L, Cabañero A, López I, Sánchez D, Figueroa S, Salcedo JG, Campo-Cañaveral JL, Genovés M, Hernando F, Moldes M, Blanco A, Azcarate L, Rivo E, Viti A, Mongil R. "Complex segmentectomies: Comparison with simple and effect of experience on postoperative outcomes". Eur J Surg Oncol. 2025 Jul;51(7):109748. doi: 10.1016/j.ejso.2025.109748. Epub 2025 Mar 5. PMID: 40064065. https://pubmed.ncbi.nlm.nih.gov/40064065/ Perroni G, Veronesi G. Robotic segmentectomy: indication and technique. J Thorac Dis. 2020 Jun;12(6):3404-3410. doi: 10.21037/jtd.2020.02.53. PMID: 32642266; PMCID: PMC7330783. https://pubmed.ncbi.nlm.nih.gov/32642266/ Montagne, F., Dhainaut, C., & Benhamed, L. M. (n.d.). Pre-operative 3D reconstruction—let’s first anticipate the surgical procedure. Video-Assisted Thoracic Surgery. Retrieved November 13, 2025, from https://vats.amegroups.org/article/view/7889/html Shimizu K, Nakazawa S, Nagashima T, Kuwano H, Mogi A. 3D-CT anatomy for VATS segmentectomy. J Vis Surg. 2017 Jul 1;3:88. doi: 10.21037/jovs.2017.05.10. PMID: 29078650; PMCID: PMC5637987. https://pubmed.ncbi.nlm.nih.gov/29078650/ Zhang O, Alzul R, Carelli M, Melfi F, Tian D, Cao C. Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer. J Pers Med. 2022 Aug 12;12(8):1311. doi: 10.3390/jpm12081311. PMID: 36013260; PMCID: PMC9410342. https://pubmed.ncbi.nlm.nih.gov/36013260/ Lee BE, Altorki N. Sub-Lobar Resection: The New Standard of Care for Early-Stage Lung Cancer. Cancers (Basel). 2023 May 25;15(11):2914. doi: 10.3390/cancers15112914. PMID: 37296877; PMCID: PMC10251869. https://pubmed.ncbi.nlm.nih.gov/37296877/ Zhang Y, Liu S, Han Y, Xiang J, Cerfolio RJ, Li H. Robotic Anatomical Segmentectomy: An Analysis of the Learning Curve. Ann Thorac Surg. 2019 May;107(5):1515-1522. doi: 10.1016/j.athoracsur.2018.11.041. Epub 2018 Dec 19. PMID: 30578780. https://pubmed.ncbi.nlm.nih.gov/30578780/ Peeters M, Jansen Y, Daemen JHT, van Roozendaal LM, De Leyn P, Hulsewé KWE, Vissers YLJ, de Loos ER. The use of intravenous indocyanine green in minimally invasive segmental lung resections: a systematic review. Transl Lung Cancer Res. 2024 Mar 29;13(3):612-622. doi: 10.21037/tlcr-23-807. Epub 2024 Mar 27. PMID: 38601441; PMCID: PMC11002498. https://pubmed.ncbi.nlm.nih.gov/38601441/ Altorki N, Wang X, Damman B, Mentlick J, Landreneau R, Wigle D, Jones DR, Conti M, Ashrafi AS, Liberman M, de Perrot M, Mitchell JD, Keenan R, Bauer T, Miller D, Stinchcombe TE. Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance). J Thorac Cardiovasc Surg. 2024 Jan;167(1):338-347.e1. doi: 10.1016/j.jtcvs.2023.07.008. Epub 2023 Jul 18. Erratum in: J Thorac Cardiovasc Surg. 2025 Apr;169(4):1181. doi: 10.1016/j.jtcvs.2024.12.011. PMID: 37473998; PMCID: PMC10794519. https://pubmed.ncbi.nlm.nih.gov/37473998/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. 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