Modified free pericardial fat pledget technique for intraoperative air leak management in robotic-assisted thoracic...

Prolonged air leakage following pulmonary resection is a common complication, and reliable intraoperative repair of lung fistulas is crucial. This study aimed to evaluate the feasibility and efficacy of a modified free pericardial fat pledget technique tailored to solo robot-assisted thoracic surgery.

A retrospective study was conducted at Sapporo Medical University Hospital between April 9, 2018, and May 31, 2024, comparing conventional and modified free pericardial fat pledget techniques in patients who underwent anatomical lung resection requiring air leak repair. Harvesting and suturing times were measured. Patient characteristics, intraoperative findings, and postoperative outcomes were analyzed.

In total, 14 and 26 air leaks were repaired in the conventional and modified free pericardial fat pledget groups, respectively. The modified technique significantly reduced the median total suturing time [335 (interquartile range, 264-440.7) vs. 426.5 (interquartile range, 376-464) sec, P=0.02] and no suture entanglements were observed [0 vs. 6 (42.8%) sites, P<0.001] compared to the conventional technique. The modified group also included more surgeries performed by surgeons not certified as robot-assisted thoracic surgery proctors. No additional sealant was required in either group. Postoperative outcomes were not significantly different between the two groups.

The modified free pericardial fat pledget technique simplified intraoperative handling, reduced total suturing time, and prevented suture entanglement in this series. This novel technique is feasible even for surgeons with limited robot-assisted thoracic surgery experience and is well suited for solo robot-assisted thoracic surgery, offering a practical and efficient solution for intraoperative air leak management.