[Refinements in Operative Field Exposure and Bronchial Anastomosis for Robot-assisted Thoracic Surgery Sleeve...

Sleeve lobectomy remains one of the most challenging procedures in thoracic surgery. To date, reports on robotic-assisted thoracic surgery (RATS) sleeve lobectomy are limited, with most literature focusing on right upper lobe reconstructions. Notably, even Cerfolio's landmark reports do not detail bronchial wedge resection or sleeve lobectomy of the middle and lower lobes. Using a 0° scope with an upward-viewing technique allows for the observation of target bronchi in the middle and lower lobes from a low intrathoracic angle. Although the interlobar pulmonary artery often obstructs the bronchial view in this approach, strategic retraction of the artery and lung parenchyma creates sufficient space for precise robotic anastomosis. The robotic platform provides a three-dimensional (3D) magnified view and enhanced dexterity, facilitating complex suturing even in narrow spaces. This surgical approach and the specific tips for field exposure may facilitate the wider adoption of minimally invasive bronchoplasty across various institutions.