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International Society For Minimally Invasive Cardiothoracic Surgery

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Robot Assisted Intrapericardial Salvage Pneumonectomy
Farhan Nadeem, Charles Bakhos, Shrey Patel, Roman Petrov, Abbas Abbas
Temple University Hospital, Philadelphia, PA, USA

Background: After definitive chemoradiation therapy, non-small cell lung cancer (NSCLC) recurrence is seen in 24-35% of patients with locally advanced disease. For this group of patients, salvage surgery consisting of surgical resection is a feasible option leading to 3 year survival approaching 40%. Perioperative morbidity and mortality with this approach is understandably higher compared to patients undergoing curative surgery with localized disease. Minimally invasive techniques in these cases can be used in an attempt to decrease procedure associated complications. Technical difficulty and complexity advocates for the use of Robotic platform in these challenging cases.
Methods: We present a 72 Male with BMI of 45 with history of thoracoscopic left upper lobectomy for T2aN0 adenocarcinoma performed 3 years ago had already undergone stereotactic body radiotherapy (SBRT) for local recurrence at bronchial stump. Subsequently, he underwent chemotherapy and received pembrolizumab for local recurrence at pulmonary artery. He now presented with evidence of persistent localized tumor adjacent to left main pulmonary artery.
Results: Technical aspects of the procedure are thoroughly elucidated in the video. Conclusion: Robotic platform provides distinct advantage in performing complex surgical resection in post chemoradiation patients with hostile operative fields. Salvage resections when performed robotically are both technically feasible and safe.


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