Postoperative Ischemic Bronchitis Progressing to Bronchopleural Fistula After Robotic Lobectomy: A First Report

Area of Science:

• Thoracic Surgery
• Pulmonology
• Surgical Complications

Background:

• Postoperative ischemic bronchitis (POIB) is a known precursor to bronchopleural fistula (BPF) after lung resection.
• POIB has been reported following open thoracotomy but not previously after robotic lobectomy.
• Robotic lobectomy allows for more extensive lymphadenectomy, potentially increasing POIB risk.

Purpose of the Study:

• To report a case of POIB progressing to BPF after robotic lobectomy.
• To raise awareness of POIB as a potential complication of robotic lung resection.
• To suggest systematic postoperative bronchoscopy for early POIB detection.

Main Methods:

• Case report of a 51-year-old male undergoing robotic-assisted right lower lobectomy for lung adenocarcinoma.
• Postoperative development of dyspnea and hemoptysis.
• Diagnostic bronchoscopy revealing significant ischemic changes and necrosis of the right mainstem bronchus.

Main Results:

• The patient developed POIB with a large defect in the right mainstem bronchus.
• Surgical repair of the bronchial defect was performed.
• Follow-up bronchoscopy confirmed complete healing of the right mainstem bronchus.

Conclusions:

• POIB is a potential complication of robotic lobectomy, even in the absence of prior reports.
• Pulmonologists and thoracic surgeons should consider POIB in patients presenting with relevant postoperative symptoms.
• Systematic postoperative bronchoscopy (days 7-12) may aid early detection and prevention of BPF in high-risk patients.