Intraoperative complications and troubles in robot-assisted anatomical pulmonary resection

Regarding intraoperative complications and troubles during robot-assisted thoracic surgery, few data are available especially in Japan. This study was aimed to elucidate intraoperative complications and troubles in robotic anatomical lung resection, and to present managements and outcomes of those.

This was a retrospective singe-institutional study. The first 192 consecutive patients who underwent robot-assisted anatomical lung resection between January 2017 and August 2019 were evaluated. We examined the frequency, management and outcomes of intraoperative complications and troubles.

Of the 192 eligible patients who underwent robotic anatomical lung resection, lobectomy was performed for 156 (81.2%), and segmentectomy for 36 (18.8%). Three (1.5%) required conversion to open thoracotomy. Of these, bleeding from the pulmonary artery was the cause in two patients (1.0%) and inflammatory adhesion of hilar lymph nodes in 1 (0.5%). Other intraoperative complications and troubles included bronchial injuries in 3 patients (1.5%), lung injury by assistant in one patient (0.5%) and horizontal movement limitation of da Vinci arm in one patient (0.5%). Regarding bronchial injuries, two of three were stump injuries related to stapling, the remaining was to dissection of the bronchial tissues. All bronchial repairs were completed without conversion, and postoperative complications related to bronchial injury were not observed. The 30-day and 90-day mortality rates were both 0%.

The frequency of intraoperative complications and troubles in robot-assisted thoracic surgery was low in our first series. All conversions were related to bleeding and impending bleeding, and no conversion was required for bronchial injury.