Minimally invasive robotic surgery for left lower lobe arteriovenous malformation

Mme L., a 53-year-old female with a history of controlled hypertension, cervical disc herniation, and prior breast prosthesis implantation, presented in September 2023 with isolated sixth cranial nerve palsy. Neurological and ophthalmological evaluations were normal aside from the palsy. Magnetic resonance imaging (MRI), blood tests, and electromyography showed no abnormalities. A thoracic computed tomography (CT) scan, performed to rule out a thymic lesion, revealed a 53 × 25 × 40 mm bilobed cystic lesion in the left lower lobe, associated with a vascular structure forming an arteriovenous loop between the pulmonary artery and vein. There were no respiratory, digestive, or bleeding symptoms, and no features of Osler-Weber-Rendu disease. Given the lesion's complexity, multiple multidisciplinary teams reviewed the case. Embolization was considered; however, the interventional radiology teams deemed the procedure technically difficult, and after discussion of risks and benefits in a multidisciplinary setting, the patient preferred surgical resection. To reduce the risk of paradoxical emboli, surgical resection was chosen. In September 2024, Mme L. underwent successful robot-assisted thoracic surgery at Pontchaillou Hospital, Rennes, using the da Vinci XI system. Four trocars were used to resect the lesion, and the malformation was ligated with 5-0 polypropylene sutures and surgical clips. The patient had an uneventful recovery and was discharged on postoperative day four. CT imaging confirmed the absence of complications. Histopathology showed an emphysematous lesion without malignancy. At 1-month and 6-month follow-ups, the patient remained asymptomatic. This case demonstrates a safe and effective robotic surgical approach to a rare pulmonary arterio-venous malformation.

The online version contains supplementary material available at 10.1007/s12055-025-02131-2.