Robotic Sleeve Lobectomy of the Left Upper Lobe for a Central Carcinoid Tumor: A Case From Foch Hospital

The authors present the case of a 55-year-old woman with no significant medical history who was incidentally diagnosed with atelectasis of the left upper lobe. Imaging and bronchoscopy identified a 4 cm localized endobronchial lesion obstructing the left upper lobe bronchus, which was confirmed by biopsy as a carcinoid tumor. 
 
The patient underwent a robotic-assisted left upper lobectomy with bronchial sleeve resection and end-to-end anastomosis. Bronchial reconstruction was performed using two running 4-0 V-Loc barbed sutures for the posterior and anterior walls of the bronchus. The needle used was a 17 millimeter, half-circle taper needle with a round tip. 

Anatomically, the main technical challenge of left upper sleeve lobectomy lies in the close proximity between the pulmonary artery and the bronchial anastomotic site. In this case, satisfactory exposure was achieved by suspending the artery with a multi-tubular silicone sheet, secured by the fourth robotic arm. A pedicled pleural flap was interposed between the bronchial anastomosis and the pulmonary artery. 
 
Final pathology confirmed a 2.5 cm atypical carcinoid that was completely resected with negative margins (pT1cN0). The postoperative course was uneventful, and excellent bronchial healing was observed at the three-month follow-up bronchoscopy. 
 
This case underscores the feasibility and safety of a robotic-assisted approach for the management of centrally located carcinoid tumors requiring bronchoplastic resection. 

References

1. Uchida S, Suzuki K, Kinjo K, Sumiya R, Niimi T, Watanabe Y, Fukui M, Hattori A, Matsunaga T, Takamochi K. Surgical techniques for robotic portal complex sleeve resection of the left lower lobe and lingula. JTCVS Tech. 2025 May 15;32:188-191. doi: 10.1016/j.xjtc.2025.04.020. PMID: 40814668; PMCID: PMC12347282.
2. Rusca Giménez M, González-Rivas D, Tabales JG, Bosinceanu ML, Wolf JI, Jiménez DE. Uniportal robotic-assisted sleeve resection of the left main bronchus and secondary carinal reconstruction for typical carcinoid tumor. Eur J Cardiothorac Surg. 2025 Aug 26:ezaf280. doi: 10.1093/ejcts/ezaf280. Epub ahead of print. PMID: 40855697.
3. Rusca Giménez M, González-Rivas D, Tabales JG, Bosinceanu ML, Wolf JI, Jiménez DE. Uniportal robotic-assisted sleeve resection of the left main bronchus and secondary carinal reconstruction for typical carcinoid tumor. Eur J Cardiothorac Surg. 2025 Aug 26:ezaf280. doi: 10.1093/ejcts/ezaf280. Epub ahead of print. PMID: 40855697.

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