Robotic-Assisted Bronchoplasty: Technique Using Unidirectional Barbed Suture

In this video, the authors demonstrate a technique of robotic-assisted bronchoplasty using a continuous unidirectional barbed suture. The patient was a 23-year-old woman with a recent diagnosis of asthma, who presented to the clinic after an incidental finding of an endobronchial lesion and right lower lobe collapse, which was discovered during an emergency department visit and evaluation for abdominal pain.

A dedicated chest computed tomography (CT) was obtained, clearly visualizing the lesion within the bronchus intermedius, with what appeared to be adequate margins to facilitate a stapling device. However, at the time of bronchoscopy, the lobulated endobronchial mass was located about 1 cm from the takeoff of the right upper lobe bronchus and was obstructing approximately 90% of the bronchial lumen. Bronchial washings and brushings were taken, and pathology was consistent with a well-differentiated neuroendocrine tumor, also called a typical carcinoid tumor, with Ki-67 <3%. A DOTA-TATE positron emission tomography/CT showed an isolated lesion in the right lung with an standardized update value max of 38. There was no locoregional adenopathy or evidence of distant disease.
The patient was taken to the operating room with plans for a robotic lower bilobectomy and bronchoplasty. The authors review and describe key procedural steps, emphasizing anatomical landmarks and keys to success along the way. Highlighted in this video is a robotic-assisted bronchoplasty. The authors closed the proximal bronchus intermedius with two 4-0 V-loc 180 absorbable sutures, starting from each end and overlapping several stitches.

The patient recovered well and was discharged on postoperative day number four. Final pathology revealed a 1.2 cm typical carcinoid with no necrosis or increase in mitotic activity. No adjuvant therapy was indicated. She will undergo routine surveillance with chest CT scans every six months for two years and then annually for ten years.  

Suggested Reading

1. Petrella F, Mariolo AV, Guarize J, Donghi S, Girelli L, Rizzo S, et al. Bronchial carcinoid in anomalous right upper bronchus: a "patient-tailored" bronchoplasty resection technique. J Vis Surg. 2018 Apr 27;4:81.
2. Kuo SW, Huang PM, Lin MW, Chen KC, Lee JM. Robot-assisted thoracic surgery for complex procedures. J Thorac Dis. 2017 Sep;9(9):3105-3113.
3. Yang SM, Kuo SW, Lee JM. Robot-assisted thoracoscopic bronchoplasty. J Vis Surg. 2015 Nov 18;1:20.