The authors present a robotic-assisted right bilobectomy performed for coexisting right upper lobe bronchiectasis and synchronous middle lobe adenocarcinoma, highlighting the management of dual pathology in the setting of dense inflammatory adhesions.
A 45-year-old male with a longstanding history of cough and dyspnea was found to have localized bronchiectasis in the right upper lobe along with a suspicious lesion in the middle lobe, which was subsequently confirmed as adenocarcinoma. Preoperative imaging suggested chronic inflammatory changes, and intraoperatively, dense pleuroparenchymal and hilar adhesions were encountered, adding significant technical complexity to dissection.
The procedure emphasizes key operative principles, including careful adhesiolysis, meticulous hilar dissection, and precise identification and control of the upper and middle lobe pulmonary arterial branches. The presence of dense adhesions necessitated a deliberate and layered approach to vascular exposure to ensure safe division while minimizing the risk of bleeding. Sequential bronchial division and systematic lymphadenectomy were performed, with particular attention to preserving right lower lobe vascularity and bronchial integrity.
The robotic platform provided enhanced visualization and dexterity, enabling controlled dissection in a hostile operative field. Despite the complexity, the procedure was completed safely without conversion.
The postoperative course was uneventful. Chest radiography on postoperative day zero demonstrated a transient air-fluid level, which resolved prior to discharge. At six-month follow-up, imaging confirmed a well-expanded right lower lobe with no evidence of disease recurrence.
This case demonstrates that robotic-assisted thoracic surgery can be effectively applied to complex pulmonary resections involving dense adhesions and synchronous pathology, achieving precise dissection, oncologic adequacy, and excellent functional outcomes.
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