Original article
General thoracic
Robotic Bronchial Sleeve Lobectomy for Central Lung Tumors: Technique and Outcome

https://doi.org/10.1016/j.athoracsur.2019.02.028Get rights and content

Background

The use of the surgical robot for standard lobectomy has widely spread worldwide. However there are relatively few studies of robotic bronchial sleeve lobectomy for central lung tumors.

Methods

We retrospectively evaluated 67 consecutive patients who underwent robotic bronchial sleeve lobectomy, a procedure without pulmonary vessel end-to-end anastomosis, performed by a single surgeon between October 2014 and March 2018. A half-continuous suture technique with two Prolene (Ethicon, Inc, Somerville, NJ) sutures for bronchial anastomosis was applied. The operative techniques and outcomes were analyzed.

Results

Complete resection was achieved in all patients undergoing different types of robotic bronchial sleeve lobectomy. There were no conversions to thoracotomy. The mean total surgical duration was 166.5 minutes (range, 78–286), total bronchial anastomosis time was 20.8 minutes (range, 10–44), estimated blood loss was 98.8 mL (range, 20–300), and postoperative hospital stay was 6.8 days (range, 4–13). No patient died within 90 days after surgery. The postoperative morbidity rate was 20.9%. Multivariate analysis showed that preoperative comorbidity, older age, and surgeon’s early experience were risk factors for postoperative morbidity.

Conclusions

Robotic bronchial sleeve lobectomy and the novel anastomotic technique are both feasible and safe for carefully selected patients.

Section snippets

Patients

We reviewed our thoracic surgery database of patients with pulmonary tumors. Between October 2014 and March 2018, 67 patients underwent curative robotic bronchial sleeve lobectomy at the Affiliated Hospital of Qingdao University (Qingdao, China) (Table 1). The study protocol was approved by the Institutional Ethics Committee.

The inclusion criteria for robotic bronchial sleeve lobectomy were as follows: tumors were located at the origin of the lobar bronchus, the presence of direct infiltration

Baseline Characteristics

The baseline characteristics of all 67 patients who underwent robotic bronchial sleeve lobectomy are summarized in Table 1. Most patients were men (82.1%, 55/67) and had a history of smoking (80.6%, 54/67). Right-sided (59.7%, 40/67) tumors were more common than left-sided tumors.

Intraoperative Characteristics

Most procedures (64.2%, 43/67) were upper single-sleeve lobectomy (Table 2). All 67 patients underwent radical resection and successful bronchial anastomosis using the da Vinci robotic system with no conversions to

Comment

In this report we share our experiences with robotic bronchial sleeve lobectomy in 67 patients with centrally located pulmonary tumors. We attempted to demonstrate the surgical technique and outcome for this complex lung surgeries. Among all patients anastomosis of the cartilaginous and membranous parts of the bronchus was completed by a novel technique, a half-continuous suture with two Prolene sutures. All procedures, including suturing and tying of the knots, were performed with robotic

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∗

Drs Jiao, Zhao, and Qiu contributed equally to this work.

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© 2019 by The Society of Thoracic Surgeons Published by Elsevier