[Improved Surgical Technique for Safe Bronchoplasty Suitable for Robot-assisted Thoracic Surgery]

Robot-assisted thoracic surgery( RATS) is increasingly used in difficult surgeries because of its excellent operability with three-dimensional stereoscopic visual fields and multiple joints. RATS is useful for suture procedures, but not for ligation procedures due to lack of sense of touch, which is needed for precise power adjustment. In this report, we describe bronchoplasty with RATS in a case of right upper lobe resection. A large needle driver and Cadiere forceps were used with the right and left hands, respectively, as instruments for bronchorrhaphy. Barbed suture( V-Loc 180 closure device, 3-0, 15 cm)with a looped thread end was used to minimize the number of ligations for bronchorrhaphy. The 3-0 suture was selected to avoid the risk of cutting a thread. Continuous suture was performed using each of two threads for the semiperimeter of the bronchus clockwise and counterclockwise from the deepest part, and the two threads were ligated where they met. The bronchus was tightened slowly at each stitch, and the last three stitches were made with the bronchus opened. Finally, the threads were carefully pulled to tighten the bronchus. This case indicates that robot-assisted bronchoplasty with continuous suture can be performed safely with no stress.