Robotic Left Upper Lobe Sleeve Lobectomy

We present the case of a 20-year-old man who presented with 3 days of fever and headache, as well as a dry cough and dysgeusia.  A chest CT scan was performed and a lesion in the left upper lobe was observed. The previous medical history included toxic megacolon and a viral pericarditis.

The PET scan showed a hypermetabolic endobronchial lesion in the left upper lobe bronchus, resulting in atelectasis of the entire lobe. A bronchoscopy was performed and a rounded lesion was observed that occupied the entire LUL bronchus. A biopsy of this lesion was performed and the result was a typical carcinoid tumor. The case was presented at the tumor board, and it was decided to perform a RATS left upper lobe sleeve lobectomy.

Surgical Technique

After port placement, we performed division of the inferior pulmonary ligament and harvest of the lymph node in station 9. After anterior retraction of the lung, we dissected the posterior mediastinal pleura and the pulmonary hilum posteriorly, and harvested station 7. Then we dissected the anterior hilum and the left superior pulmonary vein. After that, we reached the artery via the fissure, using a combination of monopolar and bipolar energy. We completed the anterior and posterior fissure using robotic staplers and then we sectioned the arterial branches of the left upper lobe and the left upper pulmonary vein with robotic staplers. We harvested station 11 and retracted the remaining pulmonary artery posteriorly using a Penrose drain to improve the exposure of the bronchus. The bronchus was cut using monopolar robotic scissors. A frozen section of the bronchial margin was performed and it was negative for malignancy.

Once the main bronchus and the lower left lobe bronchus had been sectioned and dissected, we performed a bronchial anastomosis using a running suture with V-Loc 4/0. The patient was extubated in the immediate postoperative period and the chest tube was removed. The patient was discharged uneventfully on postoperative day nine. The pathological examination showed a typical carcinoid tumor, and the final staging was pT1bN0.

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