[Current Status and Challenges of Robotic Bronchoplasty:Initial Experience at Kobe University]

Robot-assisted thoracic surgery( RATS) has become widely adopted as a standard minimally invasive approach for lung cancer surgery. While bronchoplasty has traditionally been performed via thoracotomy or video-assisted thoracic surgery( VATS), its application under robotic assistance remains limited, and practical experience has yet to be fully established. Our institution introduced RATS in 2018 and has accumulated substantial experience with standardized surgical procedures. After sufficient experience was obtained, bronchoplasty using the da Vinci system was introduced in a planned manner for carefully selected cases in which pneumonectomy could be avoided. To date, four cases of planned robotic bronchoplasty have been performed. Simple bronchial stump closure and unintentional bronchial injury repair were excluded from this series. Bronchial anastomosis was performed using either 4-0 Prolene or 4-0 PDS Stratafix, selected according to anatomical conditions. The high-definition three-dimensional visualization and articulated instruments provided by the robotic system allowed precise needle control and uniform suture placement. Continuous suturing was primarily employed, with careful attention to tension control and accurate mucosal alignment. Stable operative fields were achieved through a cooperative team-based approach, in which the assistant consistently managed exposure, suction, hemostasis, and stapling procedures. All procedures were completed robotically without conversion to thoracotomy. No intraoperative complications or bronchial anastomosis-related postoperative complications, including leakage or stenosis, were observed. Postoperative courses were uneventful in all cases. Although our experience is limited, these findings suggest that robotic bronchoplasty can be safely performed when appropriate patient selection, standardized techniques, and close collaboration between the console surgeon and assistant are ensured. Further accumulation of cases is necessary to clarify the role of robotic bronchoplasty in lung cancer surgery.