Technical Considerations for Robotic Pediatric Lobectomy

Robotic thoracic surgery in pediatric patients is technically challenging due to narrow anterior-posterior and lateral chest dimensions, which increases instrument collisions. Consequently, lung tumors in children are traditionally resected through a thoracotomy. We present a reproducible approach to robotic pediatric lobectomy in a 12-year-old girl with a biopsy specimen-proven left lower lobe mucoepidermoid carcinoma. Our technique uses 4 robotic ports, with 3 posterior ports in the ninth intercostal space and an anterior stapling port positioned 1 to 2 interspaces higher, achieving 6 to 8 cm of spacing. Preoperative marking and careful patient selection enable a feasible robotic lobectomy within the constrained pediatric thorax.