Left Robotic Completion Pneumonectomy

The patient was a 71-year-old woman with a bronchiectatic left upper lobe lesion that was under surveillance. She had a biopsy-proven adenocarcinoma in the left lower lobe, normal pulmonary function tests, and no signs of nodal disease or spread outside of the left lung. The initial surgical plan was a left video-assisted thoracoscopic (VATS) lobectomy. 

Wedge resection of the bronchiectatic area in the upper lobe was performed. However, the intraoperative frozen sectioning showed adenocarcinoma, so an upper lobectomy was performed. The surgical plan was then changed, as multiple nodules were palpated in the lower lobe. The patient was woken up and she consented to a pneumonectomy. A robotic approach was utilized, incorporating the existing VATS ports. The left main pulmonary artery, lower lobe vein, and left main bronchus were successfully stapled with traditional robotic staplers. The specimen was removed by extending an access port to join a working port. The patient was discharged on postoperative day three with no complications.

Suggested Reading

1. Khan N, Fikfak V, Chan EY, Kim MP. “Five on a dice” port placement allows for successful robot-assisted left pneumonectomy. Thorac Cardiovasc Surg Rep. 2017;6(1):e42-e44.