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BACKGROUND: Decortication of dense noninflammatory adhesions is performed in patients with distant pulmonary infections and prior thoracic surgery. Open decortication is cumbersome and can result in multiple pulmonary parenchymal injuries. Although video-assisted thoracoscopic surgery (VATS) can be used, there is limited success especially in patients with dense adhesions, resulting in a high conversion rate. The unique capabilities of the robot, specifically three dimensional visualization, fine instrument dissection, and tremor control enables decortication of the lung in the setting of fibrothorax.
METHODS: A 70 year old man with a distant history of empyema and fibrothorax underwent robotic transthoracic decortication. The procedure was performed with 3, 2cm incisions. Robotic hook cautery in each robotic arm was used for pulmonary decortication. Success was determined by complete inflation of the lung intraoperatively and postoperative CXR.
RESULTS: Operative time was 90 minutes. There were no complications and no mortality. There was no air leak and hospital stay was 3 days. The chest tube was removed prior to discharge from the hospital.
CONCLUSION: Robotics allows for a minimally invasive procedure with a 3D magnified view, fine dissection, and tremor control all of which minimizes pulmonary parenchymal injury. Greater experience is necessary to fully assess the role of robotics in pulmonary decortication.