Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy

Video-assisted thoracoscopic (VATS) lobectomy has been demonstrated to be safe and feasible. However, only a few reports exist on minimally invasive sleeve lobectomy. In most of these, bronchial anastomoses were accomplished in an open surgical technique through a minithoracotomy. We report on a combined robotic and VATS approach for a true minimally invasive right upper sleeve lobectomy. To our knowledge it is the first report of this kind.

A 30-year-old female patient presented with a low grade neuroendocrine tumor occluding the orifice of the right upper lobe bronchus. A complete minimally invasive right upper sleeve lobectomy was performed. Dissection and individual control of the right upper lobe pulmonary vessels was performed through three 1.5 to 2 cm incisions by means of conventional VATS. The specimen was retrieved through the upper thoracocentesis, which was enlarged to 4.5 cm. For airway reconstruction, a bronchial anastomosis between the right intermediate and the right main bronchus was performed with the da Vinci robot through the same incisions.

Intraoperative blood loss was minimal and total operative time was 364 minutes. The postoperative course was uneventful. Chest X-rays showed no sign of atelectasis. The chest tube was removed on postoperative day 9 due to prolonged pleural effusion. Bronchoscopy on postoperative day 14 showed a patent right airway and a well healing anastomosis. The patient was discharged on postoperative day 15.

The da Vinci robot provides a benefit in more complex thoracic procedures like pulmonary sleeve resections. It is an ideal tool to perform delicate surgical maneuvers in vulnerable and difficult to reach anatomic areas. The study of the literature shows that VATS sleeve lobectomy is being performed in dedicated centers only with a low morbidity.