Robot-assisted right wedge-shaped sleeve lower bilobectomy with knotless suture anastomosis: a case report

In bronchoplasty of wedge resections, it is necessary to transect the bronchus at a sharp angle and depth. As a result, anastomoses after wedge resections have the disadvantages of poor visibility and operability. Here, we report a case of right wedge-shaped sleeve bilobectomy that was successfully performed with continuous knotless suturing using robotic assistance.

An 81-year-old male patient was referred for the treatment of a tumor in the right lower lobe, which protruded into the bronchus intermedius. The tumor was diagnosed as squamous cell carcinoma by transbronchial biopsy, cT1cN1M0 stage IIB carcinoma for which surgery was indicated. Because the pulmonary middle lobe artery was involved and a resection margin from the tumor protruding into the bronchial mucosal epithelium was necessary, a right wedge-shaped sleeve bilobectomy was performed. The bronchial anastomosis was performed with robotic assistance. After dissection of pulmonary vessels and interlobes, the upper lobe bronchial bifurcation was transected in a wedged shape, and a lower bilobectomy was performed. The bronchi were sutured continuously with knotless sutures. A continuous suture was performed from the ventral to the caudal side. After suturing to the dorsal side, another continuous suturing was performed from the cranial side. Continuous sutures were made until each thread passed through the other. Pericardial fat was wrapped around the anastomosis.

A better visual field could be obtained owing to robot-assisted surgery, and robotic arms enabled an accurate and safe operation. Furthermore, continuous suturing using a knotless suture made it easier for the sutures to be handled and enabled bronchial anastomosis without assistance.