[Current Status and Technical Skills in Bronchoplasty and Angioplasty during Robot-assisted Thoracic Surgery]

Robot-assisted thoracoscopic surgery (RATS) has reached approximately 10,000 cases annually in Japan and has been established as one of the minimally invasive approaches. In the coming years, as institutions accumulate more experience, the indications are expected to expand to more complex cases. Among these, suturing techniques required for bronchial and pulmonary vessel reconstruction are particularly valuable in RATS due to the multi-articulated instruments;however, their frequency remains limited since resection procedures constitute the mainstay of thoracic surgery. Moreover, the typical candidates are technically and oncologically challenging cases, such as central lung cancer and locally advanced lung cancer with hilar lymph node involvement. Therefore, it is essential to share and systematically accumulate technical refinements and insights based on experience, including the use of barbed sutures in bronchial anastomosis and clamp management during pulmonary artery reconstruction. Mastery and practice of these technical skills by a greater number of thoracic surgeons will form the foundation for ensuring the safety and further effective development of RATS in Japan.