Case report of sequential, bilateral, robotic-assisted lung resections for severe bronchiectasis

Resection of infected and destroyed lung tissue refractory to medical therapy can improve symptoms and prevent further spread in patients with bronchiectasis. However, bilateral resections are not recommended and recent guidelines state that surgery should only be considered for focal disease confined to a single lobe. When surgery is undertaken for bilateral disease, it is often performed months apart, risking spread of infection and requiring separate antibiotic courses.

A patient with severe bronchiectasis and repeated isolation of Pseudomonas, Stenotrophomonas, and Tsukamurella on sputum cultures despite years of optimal medical therapy was referred to our multidisciplinary group. After one course of intensive, perioperative antimicrobials, the patient underwent sequential, robotic-assisted lobectomies-first of the right middle and then of the left lower lobe-separated by one week. She was discharged two days after each resection, and there were no complications.

During close follow up over 38 months, her symptoms, pulmonary function, and microbiology testing have improved considerably. In select patients bilateral robotic-assisted resections performed within a week can be considered are part of the treatment paradigm of severe bronchiectasis when paired with an intense single course of appropriate antibiotics.