Robot-assisted Resection of Endobronchial Lipomatous Hamartoma with Hilar Extension

Abstract

Endobronchial lipomatous hamartoma with hilar extension is a very rare benign disease of the airway. A 78-year-old male with coronary artery disease and a coronary stent presented with worsening shortness of breath. The workup included a computed tomography (CT) scan of the chest that showed a nearly obstructive lipomatous endobronchial lesion in the right bronchus intermedius with 2 cm hilar extension of the lipomatous mass. We performed a robot-assisted resection of the lipomatous mass using the "five on a dice" port placement for the Da Vinci Xi robot. In order to fully obtain the exposure necessary to resect the mass and the endobronchial lesion, we performed a right lower lobe superior segmentectomy. The margin of the parenchyma was determined using indocyanine green angiography and divided with the robot blue load stapler. The mass was carefully separated from the pulmonary artery and divided from the endobronchial portion. The frozen section showed that it was a lipomatous mass without any signs of malignancy. We then resected the endobronchial mass with robot scissors and the pathology was consistent with benign lipomatous hamartoma. Two sutures were placed as retraction sutures to pull the airway away from the pulmonary artery. We then closed the opening with absorbable sutures in an interrupted fashion. There was no air leak at the end of the case. The patient went home on postoperative day 3 without any complications and with his shortness of breath resolved. The use of the Da Vinci Xi robot allows for a successful minimally invasive method of resecting a rare endobronchial hamartoma with hilar extension.

Keywords: airway reconstruction; endobronchial lipomatous hamartoma; five on a dice port placement; pulmonary resection; robot assisted right lower lobe superior segmentectomy.