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OBJECTIVE: Minimally invasive techniques for non-oncologic lung resections especially fungal infections are not widely employed. We wish to share our protocol for management of robotic resection of pulmonary aspergillomas.
METHODS: 18 patients underwent surgical resection of post tuberculosis aspergilloma between January 2012 to July 2014 at a single centre. A 4 arm DaVinci Robot was used to perform the surgery. A standardised protocol of management was followed for all the patients.
RESULTS: 11 male and 7 female patients in the age group 35 to 78 years (mean 48 years) underwent lobectomies. As per our standard protocol all patients had received antituberculous drugs for at least 6 weeks. Systemic antifungals were given 2 weeks prior and continued for 3 months postoperatively. Extra long tubings and lines were used during the surgery in all cases. Double lumen intubation in lateral position and use of fogarty catheter helps us to prevent intraoperative spillage of aspergilloma. Our intraoperative protocol is to dissect the adhesions at the apex last as it provides good retraction and keeps the field clean and careful dissection of vascular and bronchial structures.
3 robotic cases needed completion by VATS and 2 needed conversion to open due to bleeding and frozen hilum. One patient died with multi organ failure and fungal septicaemia on day 25.
CONCLUSIONS: Robotic resection of lung is technically possible with good clinical outcomes with minimal morbidity and mortality if we standardise our protocol.