Robotic Marsupialization of a Pneumatocele

A 28-year-old lady presented with a 10-year history of a productive cough and some troublesome admissions with significant pneumonias. A very large pneumatocele was found, and bronchoscopy did not reveal a large airway connecting to it.

The author performed a robotic marsupialization of the pneumatocele and was pleased to see no adhesions in the chest. The author removed the pneumatocele outer wall, searched for bronchial connections to the remaining lung tissue, and oversewed three identified connections. This technique was facilitated by a closed chest robotic approach, whereby the author was able to inflate the lung but use CO₂ at a pressure of 8 mm Hg to maintain the space in the thoracic cavity, enabling identification of the small airway connections to the pneumatocele. The drain was taken out on postoperative day one and the patient was discharged on postoperative day two. She remains well and free from her productive cough.  

Surgical treatment of these conditions is rare (1), but the author proposes that surgery is facilitated and easily possible when done robotically.

Reference

1. Matuszczak E, Oksiuta M, Hermanowicz A, Dębek W. Traumatic pneumatocele in an 11-year-old boy – report of a rare case and review of the literature. Kardiochir Torakochirurgia Pol. 2017;14(1):59-62.