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

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 4 December 2025

⏱️ 24 minutes

🔗️ Recording | iTunes | RSS

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Summary

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/

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Transcript

Click on a timestamp to play from that location

0:00.0	Behind the Knife.
0:24.9	This is Jason here. Let's be real.
0:26.8	Preping for the cardiothoracic boards can feel like drinking from Firo's.
0:30.5	That's why we built the Behind the Knife Cardiothoracic Board Review to make the hard stuff easier.
0:35.3	It has over 70 high-yield scenarios covering everything from
0:38.5	lung cancer to ECMO, plus high-yield audio commentary from cardiothoracic faculty who've been in your
0:43.7	shoes. Whether you're deep into fellowship or reviewing before the exam, this is the one-stop
0:48.8	resource you need, all on the Behind the Knife app. Group discounts are available, enjoy the
0:53.7	episode, and dominate the day. Welcome to Behind the Knife app. Group discounts are available. Enjoy the episode and dominate the day.
0:56.7	Welcome to Behind the Knife. I'm Kyla Rikosi, a PGI, General Surgery Resident at Johns Hopkins,
1:03.5	and today I'm thrilled to be joined by an expert in thoracic surgery, professor of surgery at
1:08.6	Johns Hopkins, Dr. Stephen Yang.
1:16.4	Dr. Yang is extremely clinically active, a fierce medical student and resident advocate,
1:18.1	and master surgical educator.
1:22.5	It is a distinct privilege to get to learn from and work with you, Dr. Yang.
1:23.8	Thank you for being here.
1:25.0	Well, thanks, Kyle.
1:28.9	This is really a great honor and a thrill for me to be on behind the knife. They've listened to a handful of these. We're very excited to do this. Hopefully we can do
1:34.3	another one. And for the audience out there, Kyle is a great resident. So you'll be hearing more from
1:39.9	her in the future. So don't recruit her away from me, please. Thanks, Dr. Yang. I'm pretty excited
1:47.6	to be here with you, too. Today we're going to be discussing robotic segmentectomy. To provide a
1:53.1	brief historical context, segmentectomies weren't always used in lung cancer surgery as they
	...

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