[Robot-assisted Left Main Pulmonary Artery Clump and Plasty]

We have performed more than 100 bronchial plasties and 60 pulmonary artery plasties to date. Robot-assisted thoracic surgery was initiated at our institution in October 2018, and the da Vinci Xi system was introduced in October 2024. We recently performed a robot-assisted procedure using the da Vinci Xi system that involved left main pulmonary artery clamping and pulmonary artery plasty in a patient with pulmonary artery invasion by left hilar lymph nodes. The patient was a man in his 70s with a medical history of atrial fibrillation and prior treatment for intrahepatic cholangiocarcinoma. During follow-up, a 15-mm tumor arising from the wall of a left upper lobe cyst was identified, along with enlarged hilar lymph nodes infiltrating the A3 branch. The patient was diagnosed with cT1bN1M0, cStageⅡA non-small cell lung cancer and underwent left upper lobectomy with systematic lymph node dissection. Dissection of the hilar lymph nodes from the A3 root was technically challenging due to severe adhesion and vascular involvement. After exposing the superior pulmonary vein, the main pulmonary artery and interlobar pulmonary arteries were encircled and clamped. Following partial resection of the pulmonary artery, vascular reconstruction was performed using continuous suturing with 5-0 prolene. We plan to expand the indications for this robot-assisted technique to include bronchial reconstruction and locally invasive lung cancer, while maintaining strict safety measures.