Robotic dissection of the left internal mammary artery from the left upper lobe in a lobectomy case

Robotic-assisted lung resection in patients with prior coronary artery bypass grafting presents unique technical challenges, particularly when the left internal mammary artery is adherent to the left upper lobe. Injury to this graft can result in catastrophic myocardial ischaemia. This video tutorial describes a robotic technique for safe identification and dissection of the left internal mammary artery during left upper lobectomy. The case involves a 78-year-old man with early-stage squamous cell carcinoma of the left upper lobe and a history of coronary artery bypass grafting using the left internal mammary artery. A robotic approach was selected to facilitate meticulous dissection under high-definition three-dimensional visualization. The tutorial focuses on stepwise exposure of the graft, controlled adhesiolysis, and preservation of graft integrity while completing anatomical lobectomy and lymph node dissection. The procedure was completed without intraoperative complications. We aim to provide practical guidance for thoracic surgeons performing robotic lung resections in patients with prior mammary artery grafts, highlighting key anatomical landmarks, dissection strategies, and technical precautions to minimize risk.