Distal Bronchopleural Fistula Closure With Robotic Bronchoscopy

The inability to access distal bronchopleural fistulas with standard bronchoscopes limits the use of endobronchial occlusion techniques. A 43-year-old woman experienced fatigue and cough 1 month after a left lower lobectomy. A chest roentgenogram revealed a new air-fluid level concerning for a bronchopleural fistula. Robotic navigational bronchoscopy identified a small (∼2 mm) opening on the bronchial stump. The fistula was closed by injecting embolic sealant and endovascular coils. Robotic navigational bronchoscopy is an effective tool for localizing distal bronchopleural fistulas, thus allowing for minimally invasive closure techniques.