Impact of post-ablation pulmonary vein adhesions on robot-assisted thoracoscopic surgery lobectomy: a case report

The prevalence of atrial fibrillation (AF) is increasing in Japan, largely because of the aging population. Catheter ablation, particularly pulmonary vein isolation, is a widely adopted intervention for maintaining sinus rhythm. We report a case of robot-assisted lobectomy for lung adenocarcinoma in a patient with a history of cryoablation for AF.

A 76-year-old man with paroxysmal AF and prior cardiogenic stroke was referred for catheter ablation. Pre-ablation chest computed tomography revealed an enhancing 18 × 15 mm nodule in the right lower lobe, suggestive of lung cancer. The patient underwent cryoballoon ablation with successful pulmonary vein isolation. Three months later, a robot-assisted right lower lobectomy was performed. Intraoperatively, dense inflammatory adhesions were observed around the inferior pulmonary vein, likely induced by prior ablation, which significantly impeded dissection. The surgical technique was adapted accordingly, including the use of a 45-mm blue stapler owing to the increased tissue thickness. No adhesions were observed around the pulmonary artery or the bronchi. Lobectomy with lymph node dissection was performed without complications. The postoperative course was uneventful, and the patient was discharged on postoperative day 7.

This case highlights the need for heightened intraoperative caution during lobectomy in patients with a history of catheter ablation. Ablation-induced adhesions around the pulmonary veins can obscure anatomical landmarks and complicate robot-assisted thoracic surgery, thereby increasing technical difficulty and potential procedural risks.