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[Bronchial Stump Coverage Technique by da Vinci Xi].

Hiromitsu Domen1, Yasuhiro Hida, Hidehisa Yamada

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Kyobu Geka. the Japanese Journal of Thoracic Surgery
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Robot-assisted surgery using the da Vinci Xi system effectively prevents bronchial stump fistulas. This technique, utilizing tissue flaps for bronchial stump covering in high-risk patients, demonstrated excellent postoperative outcomes with no fistula occurrence.

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Area of Science:

  • Thoracic Surgery
  • Minimally Invasive Surgery
  • Robotic Surgery

Background:

  • Bronchial stump fistulas are serious complications following lobectomy.
  • High-risk patients, including those with diabetes or on steroid therapy, may benefit from enhanced bronchial stump closure techniques.
  • The da Vinci Xi surgical system offers advanced visualization and instrument dexterity for complex procedures.

Purpose of the Study:

  • To evaluate the efficacy of robot-assisted bronchial stump covering using the da Vinci Xi system.
  • To assess the prevention of bronchial stump fistulas in high-risk patients undergoing lobectomy.

Main Methods:

  • Retrospective analysis of 44 lobectomy cases performed with da Vinci Xi robot-assisted surgery by November 2019.
  • Thirteen patients underwent bronchial stump covering using pedicled intercostal muscle (4 cases) or free pericardial fat tissue (9 cases).
  • Surgical technique involved securing a clear visual field using the endoscope and AirSeal, with tissue flaps sutured using 3-0 or 4-0 Prolene.

Main Results:

  • All 13 patients who received bronchial stump covering experienced a good postoperative course.
  • No instances of bronchial stump fistula were observed in any of the cases.
  • The da Vinci Xi system provided excellent visualization and precise instrument control for the covering procedure.

Conclusions:

  • Robot-assisted bronchial stump covering with the da Vinci Xi system is a safe and effective method for preventing fistulas in high-risk lobectomy patients.
  • The use of intercostal muscle flaps or pericardial fat tissue is a viable option for bronchial stump reinforcement.
  • Advanced visualization and instrument articulation of the da Vinci system facilitate complex reconstructive maneuvers in thoracic surgery.