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Robotic Intrapericardial Pneumonectomy With Left Atrial Resection
Meghamsh Kanuparthy, BA, MD, Christopher Stone, MD, Kelsey Muir, MD, Hana Ajouz, MD, Haley Leesley, MD, Abbas Abbas, MD.
Warren Alpert School of Medicine at Brown Universtiy, Providence, RI, USA.
BACKGROUND: Extended pneumonectomy is an infrequently preformed but potentially curative treatment for advanced non-small cell lung cancer. In this video, we present, to our knowledge, the only published account of a totally robotic extended pneumonectomy with partial left atrial resection.
METHODS: The patient is a 56-year-old otherwise healthy woman who was found to have a 5.6 x 3.3 x 5.7 cm cavitary lesions arising from the left upper lobe. She was staged preoperatively as a T3 N0 and planned for lobectomy versus pneumonectomy. Bronchoscopy in the OR demonstrated that the mass was not amenable to sleeve resection and lobectomy. After extensive adhesiolysis the chest was entered, and the hilar contents were found to be densely adherent to the tumor. As the tumor involved the pericardium, it was incised, and the majority of our critical dissection occurred in the mediastinum. The superior and inferior pulmonary veins were found to converge into a common trunk with tumor involvement down to the pulmonary venous orifice. We resected the surrounding left atrium using a vascular load stapler. The left pulmonary artery and bronchus were similarly divided. Tumor was also found to involve the left phrenic nerve which was divided with electrocautery. A 28 French straight chest tube was placed through the assistant port and secure to the patient. The patient was extubated and discharged on hospital day 5.
RESULTS: The patient tolerated the procedure well and was extubated and returned to the PACU. She was discharge on hospital day 5.
CONCLUSIONS: Totally robotic extended pneumonectomy with left atrial resection can be performed safely and achieve R0 margins.
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