Uniportal robotic-assisted left upper lobectomy with pulmonary artery reconstruction for a central lung cancer: a...

Uniportal robotic-assisted thoracic surgery (uRATS) has emerged as an advanced minimally invasive platform for complex pulmonary resections. However, its application to centrally located lung cancers requiring vascular reconstruction following neoadjuvant chemo-immunotherapy remains technically demanding. We present a detailed surgical technique of uniportal robotic-assisted left upper lobectomy with intrapericardial venous division, bronchial transection for exposure, and pulmonary artery (PA) resection and reconstruction in a 70-year-old male with centrally located squamous cell carcinoma. The initial clinical stage was cT4N2M0. Following four cycles of neoadjuvant chemo-immunotherapy, restaging demonstrated residual soft-tissue density closely abutting the PA, with positron emission tomography-computed tomography (PET-CT) maximum standardized uptake value (SUVmax) of 2.71, consistent with residual viable tumor. Through a 4 cm uniportal incision, intrapericardial control of the left upper pulmonary vein was achieved. Due to obliteration of the PA-bronchus plane, early bronchial transection was performed to facilitate safe arterial exposure. The apicoanterior PA trunk was resected under temporary occlusion (total clamp time 26 minutes) and reconstructed using a continuous 5-0 Prolene suture. Estimated blood loss was 100 mL, and no transfusion was required. The postoperative course was uneventful. Final pathology demonstrated a complete pathological response (ycT0N0M0). This case illustrates that, in experienced hands, uRATS can be successfully applied to complex central tumors requiring bronchovascular reconstruction after neoadjuvant therapy.