PMC5748245_01
Photograph of the "five on a dice" port placement for robot-assisted left pneumonectomy. The assistant port is in the fourth intercostal space. Robot ports of 12 mm (R) are placed in the seventh intercostal space anteriorly and the ninth intercostal space posteriorly. A camera (C) is placed in the 8 mm robot port in the seventh intercostal space posterior to the posterior axillary line. The 8 mm robot port (R) is placed by the tip of the scapula (\/).
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This creates the "five on a dice" configuration ( Fig. 1 ).
Image of a stapled resection of hilar structures. The inferior pulmonary vein is divided with the robot stapler with the vascular load from the anterior inferior port (
A
); the superior pulmonary vein is divided with the robot stapler with the vascular load from the posterior inferior port (
B
); the main pulmonary artery is divided with the Endo-GIA tan load from the anterior inferior port (
C
); and the left main bronchus is divided with the robot stapler with a green load.
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We then turned our attention to the anterior hilum and dissected out the inferior pulmonary vein, which we divided using a curved tip robotic vascular stapler from the anterior inferior 12 mm port ( Fig. 2A ). Next, we dissected the superior pulmonary vein and divided it using the curved tip robotic vascular stapler from the posterior inferior 12 mm port ( Fig. 2B ). We then placed an Endo-GIA tan load stapler through the anterior inferior port around the main pulmonary artery using an introducer and divided it ( Fig. 2C ). We divided the bronchus using the robotic green stapler ( Fig. 2D ) from the anterior inferior port.