Right Main Bronchus Sleeve Resection

Introduction
Carcinoid is a rare lung cancer that originates from the neuroendocrine cells of the airways. Pulmonary parenchyma sparing procedures should be attempted whenever feasible. Bronchoplasty and sleeve resection are technically challenging, and a minimally invasive approach has been attempted in only a few dedicated centers.

Video Description
Professor Cerfolio demonstrates the adoption of a four-arm robotic technique to resect a carcinoid tumor, which originated from the right main bronchus. The ports’ positions are shown. The bronchus is isolated, and it is incised proximal to the lesion. The mass, which was occluding the right main bronchus, is excised and sent for frozen sectioning to ensure the margins’ clearance. The bronchus is dissected free from the artery. The bronchus is then completely divided and the edges are trimmed to suit the anastomosis of the proximal and distal stumps. This is achieved with two continuous 3-0 barbed sutures. Finally, the results are checked by flexible bronchoscopy, and one apical chest drain is placed.

Conclusion
The authors suggest that the robot, in view of the instrument articulation, is the ideal minimally invasive platform to perform reconstruction of the airways. Such a procedure would otherwise be performed through open surgery.

Dr Cerfolio lectures for Intuitive Surgical.