Robotic Sleeve Resection of the Bronchus Intermedius

The authors have previously described a parenchymal-sparing sleeve resection of the bronchus intermedius for isolated strictures (1). Recently, they described a robotic parenchymal-sparing bronchus intermedius sleeve resection in a patient with a benign endobronchial lesion (2). In the video here, Caso and Marshall demonstrate the technical aspects of a complete portal robotic sleeve resection of the bronchus intermedius.

The patient was a 69-year-old woman who was found to have an endobronchial lesion that was not successfully resected endoscopically. A cautery artifact obscured the diagnosis with pathology suspicious for carcinoma, however the overall clinical picture was more suggestive of a benign lesion. The patient underwent a sleeve resection of the bronchus intermedius with final pathology showing benign adenoma. She tolerated the procedure well. There were no anastomotic or other complications.

Robotic-assisted thoracic surgery is increasingly being utilized for the performance of complex thoracic procedures. However, due to the concern with performing an oncologic resection and the steep learning curve, a minimally invasive sleeve resection and bronchial anastomosis has yet to be adopted by most thoracic surgeons. This video demonstrates the feasibility and utility of robotic-assisted thoracic surgery in the management of benign pathology of the bronchus intermedius.

References

1. Paulson EC, Singhal S, Kucharczuk JC, Sterman DH, Kaiser LR, Marshall MB. Bronchial sleeve resection for posttransplant stricture. Ann Thorac Surg. 2003;76(6):2075-2076.
2. Caso R, Watson TJ, Marshall MB. Complete portal robotic sleeve resection of the bronchus intermedius. J Vis Surg. 2018;4:203.