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Case Reports
. 2024 Feb 20:11:1360125.
doi: 10.3389/fsurg.2024.1360125. eCollection 2024.

Case Report: Uniportal robot-assisted thoracoscopic double-sleeve lobectomy after neoadjuvant immunotherapy

Ziyao Fang #  1   2 , Chang Li #  1   2 , Mugurel L Bosinceanu  3 , Cheng Ding  1   2 , Jun Zhao  1   2 , Diego Gonzalez-Rivas  1   4
Affiliations
Case Reports

Case Report: Uniportal robot-assisted thoracoscopic double-sleeve lobectomy after neoadjuvant immunotherapy

Ziyao Fang et al. Front Surg. .

Abstract

Minimally invasive thoracic surgery, including video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery, has been proven to have an advantage over open thoracotomy with less pain, fewer postoperative complications, faster discharge, and better tolerance among elderly patients. We introduce a uniportal robot-assisted thoracoscopic double-sleeve lobectomy performed on a patient following neoadjuvant immunotherapy. Specialized instruments like customized trocars with a reduced diameter, bulldog clamps, and double-needle sutures were utilized to facilitate the maneuverability through the single incision. This technique integrates the merits of multiport robot-assisted thoracic surgery with uniportal video-assisted thoracoscopic surgery.

Keywords: lung cancer; minimally invasive and robotic surgery; robot-assisted thoracoscopic surgery (RATS); sleeve resection; uniportal video-assisted thoracoscopy (uniportal VATS).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PET revealed a 61.7-mm × 43.9-mm tumor near the left hilum (A). PET examination after immunotherapy revealed that the tumor was 45 mm × 44 mm (B). Bronchoscopy result (C). Contrast-enhanced CT revealed that the tumor invaded the left upper bronchus and the left upper artery (D).
Figure 2
Figure 2
Intraoperative view. (A) Left main PA was blocked by a bulldog clamp. (B) Distal PA was blocked by a bulldog clamp. (C) Left main PA was transected by the robotic scissor. (D) Left main bronchus was cut open by the robotic scissor.
Figure 3
Figure 3
Intraoperative view. (A) Anastomosis of the left main bronchus and the left lower bronchus. (B) Tracheal anastomosis was completed with a running suture. (C) Vascular reconstruction of the left main PA and the left lower PA. (D) Vascular reconstruction was completed by a running suture and fortified by a mattress suture.
Figure 4
Figure 4
Anastomosis of the left pulmonary artery and the left lower pulmonary artery with a running suture by using bulldog clamps (A). Bronchoscopy findings at the anastomotic site on the 50th postoperative day (B). Recent contrast-enhanced CT (C,D).
See this image and copyright information in PMC

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