[Robotic-assisted Sleeve Lobectomy Training Using a Three-dimensional Airway Model]

In Japan, sleeve lobectomy with bronchial reconstruction accounts for only a small proportion of all lobectomies, making it difficult to acquire sufficient technical proficiency through clinical experience alone. Therefore, structured off the job training is considered important. We have developed a training method for sleeve resection using a high-fidelity, life-sized three-dimensional (3D) airway model reconstructed from computed tomography (CT) data. Recently, robotic-assisted sleeve lobectomy has been increasingly reported. Although robotic systems provide enhanced instrument dexterity, bronchial reconstruction under robotic assistance presents specific challenges, including the lack of tactile feedback, a restricted operative field inherent to minimally invasive surgery, and the need for careful management of suture length, tension, and anastomotic technique. Even experienced surgeons may encounter approach-specific pitfalls, underscoring the importance of adequate preoperative preparation. To address these issues, the 3D model was further refined by incorporating a chest wall module that reproduces the minimally invasive surgical environment, enabling realistic robotic-assisted training. Various continuous suturing techniques, including those using short double-armed needles or absorbable barbed sutures, can be practiced in a dry-laboratory setting. This training system allows repeated practice with easy access, independent of time and location, and may contribute to improved technical skills and procedural safety in robotic-assisted sleeve lobectomy.