Robot-assisted thoracoscopic fissureless fissure-last approach versus conventional interlobar method for left lower lobectomy in lung cancer: a comparative study of short-term outcomes.

OBJECTIVES: Incomplete interlobar fissure complicates lobectomy and raises the risk of prolonged postoperative air leak. Although the fissureless fissure-last approach can reduce air leak in thoracoscopic surgery, its applicability in robot-assisted thoracoscopic surgery for left lower lobectomy remains uncertain. This study evaluated the feasibility of the fissureless fissure-last approach by comparing perioperative outcomes with those of the conventional interlobar approach. METHODS: This single-center retrospective study included 53 patients with primary lung cancer who underwent robot-assisted left lower lobectomy between November 2019 and November 2024. They were divided into a fissureless fissure-last group (n = 13) and a conventional interlobar group (n = 40), and perioperative outcomes were compared. RESULTS: Patient characteristics did not differ significantly between the groups. The severe incomplete interlobar fissure proportion was significantly higher (77% vs. 10%, p < 0.001) and operative time significantly longer (190 vs. 152 min, p = 0.011) in the fissureless fissure-last group. No conversions to thoracotomy or major intraoperative complications occurred in either group. Duration of chest drain, postoperative hospital stay, and postoperative complications were comparable between the groups. The incidence of prolonged postoperative air leak was 0% (0/13) in the fissureless fissure-last group and 5% (2/40) in the conventional interlobar group; however, the difference was not statistically significant. CONCLUSIONS: The fissureless fissure-last approach in robot-assisted left lower lobectomy appears to be a safe and feasible alternative for selected patients with severe incomplete interlobar fissure.